Signs of Memory Loss and a "Normal" Day

I again taught a class for first-time DUI offenders yesterday, Saturday. This second day of the class they read their essay on how their DUI is a wake-up call for a new life. Saturday I heard essays about going back to their Christian faith from three gentlemen. Dramatic things happen to cause us to cry out to God, as I often do on my caregivng/lovegiving journey. See here.

Early in the DUI class I share a picture of an old couple who were hit by a DUI driver two years ago here and talk about all the trouble they had. We get to the point in this 12 hour class of accepting the DUI and of moving on to never ever get a second DUI and then I remark that we are that couple in the picture, a couple who are grateful to be alive. It is very effective when these students equate us with that old couple and the motivation then is high to work to never get another DUI--so easy in our society with all our bars and cars. I often parallel my accepting my husband's dementia with my students accepting their DUI and moving on to never get another DUI. Life doesn't give us some choices.

Hubby had not taken his morning pills before I left to teach. I called when I got to the class and reminded him. Then I called two more times on breaks from the class. Finally I said, "You take your pills while I am on the phone" and he did just that. I reminded him about his lunch in the refrigerator. It is always the same so that he will recognize it: sandwich, yogurt and two coconut chocolate fudge pieces on a dinner plate.

When I returned home about four, he had not eaten his lunch, but had gotten ready to go out. No more jeans or T-shirt, but a nice button down shirt, slacks and better shoes. He likes to dress up to go out. He remembered that!

We left for the Tampa area and I used the GPS to check on where my appointment for hearing aids would be. All during the trip he kept asking what is the next thing we are doing, but was very happy to be out and about. We went to dinner at Sweet Tomatoes, a healthy buffet place. DH ate fairly well there and thoughtfully reminded me to leave a tip on the table.

"What's next?" he wanted to know, although the plans to see the  movie "Lincoln" had been made that morning. Hubby likes history so I thought this would work. The movie was great, but he didn't follow all the nuances of the characters and great acting. He said simply, "I didn't care for it."  Fortunately he wasn't agitated about sitting through the movie.

Because he doesn't eat lunch many days, he will need more supervision and the Plant City Adult Day Care Sally and I are trying out for our husbands seems just the ticket at this stage. He will get a hot lunch there and be with his friend Jake. Hubby will often ask,  "When's the next time I see Jake" and it's good for our husbands to be together which we are planning at that center.

So I move through our days accommodating hubby's memory losses and trying to hold on to the life we have. Normal? We have a calm relationship and he trusts me. It's 5 AM and I am going back to bed. Looking forward to our Sunday, today, with worship and fellowship.

Here is a good Assessment for memory loss.

Vascular Dementia Can Be Avoided

My husband was diagnosed with Vascular Dementia and Alzheimer's by a neurologist in September of 2010 as I wrote earlier. Recently I asked his primary care physician if it might only be Vascular Dementia and he said that we will only know with an autopsy.

Lifestyle can make a difference in whether someone gets Vascular Dementia or not. Last Friday I went to an Alzheimer's Association workshop in our area. One workshop presenter was a young nurse who when she was only 14 took care of her late Grandmother who had Vascular Dementia. This inspired this young lady to go into nursing and to reflect and research on Vascular Dementia.  She said that blood vessel damage to the brain is what causes this disease. One gets this disease by lifestyle choices that might be avoided. She has been losing weight she said.

Here are the lifestyle issues that she said predict who gets Vascular Dementia.

• History of heart attack, strokes or mini strokes

• Atherosclerosis

• High cholesterol HD and LDL under 100

• High blood pressure

• Type 2 Diabetes

• Smoking

I will have been married to my husband twelve years this month. In 2004 he had a heart attack, heart surgery, and contracted type 2 diabetes. He gave up smoking many years ago. He also has had carotid artery surgery shortly after the heart surgery. Hence he was a candidate for Vascular Dementia.

Many of the above conditions can be avoided with weight loss. I have never smoked, but I have had problems maintaining weight loss and regaining weight. After my husband started going downhill with dementia, he lost weight and I put on weight due to emotional eating. But this has changed recently with my rejoining Weight Watchers. I am determined to have the best possible health in my senior years and to not be one of those 60% of caregivers who die before their loved one with dementia dies. My doctor has been so pleased with my weight loss and the great blood pressure and HD and LDL readings that she wants to see me only twice a year instead of four times a year now.

My diet is certainly going well, but Weight Watchers does emphasize exercise. I am hoping to find time to exercise, but so far the main exercise I can fit into the schedule is yard work. Ugh! Do love to jog, but have been told to only walk now and hubby doesn't feel safe with my walking in our safe neighborhood. When we go to the gym, my husband just watches me. I guess I just have to accept that he will do little exercise there and fit this into my busy schedule of having to do everything, make a living, arrange for taxes, etc. Maybe I can start with a once a week gym visit and spend more time on weeding for exercise.

Some Alzheimer's and dementias will come until we find cures, but the one we do know about can be avoided early on. We certainly do not need to be the couple where both of us have Vascular Dementia.

Is Alzheimer's Hereditary?

Recently Sally and I went to a workshop on Spirituality and Alzheimer’s sponsored by our local Alzheimer’s Association. Jake and DH stayed at our home. I forgot to leave a schedule on the clipboard at home for where we were and when we would be home. Now between our two ALZ husbands, the answer for where we wives were was not contained in their memory. It wasn’t surprising, then, that both of us, forgetting to turn off our cell phones, got phone calls from our hubbies in the middle of the workshop!

At the workshop one of the speakers, a medical doctor, talked about Apolipoprotein E, better known as ApoE 2, ApoEe and ApoE4 and the hereditary connection for those who have that ApoE4 gene.

I researched and found out that 15% of us have ApoE4 in our blood. Furthermore according to this link on “Why ApoE4 Increases Alzheimer’s Risk”:

People who inherit the E4 gene from one parent are three times more likely than average to develop Alzheimer’s; those who get the gene from both parents have a tenfold risk of developing the disease.

 This information came out in April of 2007 in The Journal of Neuroscience and hence the medical community has known this statistic.

There are two types of Alzheimer’s now that have a genetic component—early-onset and late-onset. I first had the impression that only the first one of them is inherited, but they both do. Let me explain.

Early-Onset Alzheimer’s Disease strikes people from age 30 to 60 and in most cases this is inherited and known as FAD (familial Alzheimer’s disease). The AD fact sheet punished here states “A child whose mother or father carries a genetic mutation for FAD has a 50/50 chance of inheriting that mutation. If the mutation is in fact inherited, the child almost surely will develop FAD.”

Late-Onset Alzheimer’s Disease comes after age 60 and over age 85 50% may have dementia. 40 % of people who have that ApoE4 are likely to get Late Onset Alzheimer’s. See link. My husband was 71 when his AD was first diagnosed with 22 out of 30 on his Mini-Mental State Exam; I think it may have been evident when he was 70 but he scored 29 out of 30 at that time. My husband worked for the first six months after this discovery as I reported early in this blog, and is still in stage one of the disease, taking advantage of Exelon and Namenda and coconut oil and everything else I can give him including Ribonucleic Acid, D3 and turmeric.

The causes of Late-Onset are not as predictable and may include a combination of lifestyle, environmental as well as genetic factors. Many countries with different environments and food patterns do not have the epidemic of Alzheimer’s as we have. My husband's parents did not have Alzheimer’s. Researchers with GWAS (genome-wide association study) are discovering other genes that may include a risk for Alzheimer's.

My husband has not only Alzheimer’s but also Vascular Dementia. Heart trouble and diabetes can result in Vascular Dementia, but Vascular Dementia is not inherited. My husband has had a heart attack and also developed type-two diabetes with his heart attack in 2004. Perhaps we can avoid heart disease and late developing diabetes with our lifestyle choices and hence not get Vascular Dementia. This is why I am dieting now and taking measures for my own health. My health will help me continue to be my husband’s caregiver, since no insurance provision can now be purchased for his long-term nursing home care and I will be the one to offer this long-term care.

Epigenetics is a new science. The thought is that certain genes can be switched on or switched off by “environmental factors, such as exercise, diet, chemicals, or smoking, to which an individual may be exposed, even in the womb.” See this Link. One family member may get Alzheimer’s and another may not. My late father had late-developing diabetes and then strokes; his brother, my late uncle, did have both heart trouble and Alzheimer’s. My uncle was probably healthier than his brother, my father, but nonetheless he had some form of dementia at the end.

How does Alzheimer’s spread in the brain? New studies reveal that it is not a virus or bacteria that is spreading Alzheimer's in the brain, but distorted protein know as tau. In an article in The New York Times early this month  the answer came from studies at Columbia and Harvard that “it may be possible to bring Alzheimer’s disease to an abrupt halt early on by preventing cell-to-cell transmission, perhaps with an antibody that blocks tau.”   See article.

What should you do? See if you have that ApoE4 gene and take care of your health so basically you don’t switch on or off an inherited disease. New interventions and treatments are coming down the pike and the government is putting more into research for this disease. Maybe you can get in on research for the National Cell Repository for Alzheimer’s Disease by volunteering your DNA. See www.cnrad.org or call 1-800-526-2839. Another tip for young people is be sure you get long-term nursing home insurance before you might be diagnosed with AD because once diagnosed you cannot get that insurance. I have that insurance because I was not diagnosed with AD, but we can't get it for my husband.

How can you manage with these uncertainties? Prayer and waiting on the LORD. This life if not all; God is absolutely there for the patient and the caregiver who fear the LORD.

But the eyes of the LORD are on those who fear him, on those whose hope is in his unfailing love to deliver them from death and keep them alive in famine. We wait in hope for the LORD; he is our help and our shield. Psalm 33:18-20 NIV Translation

Long-Awaited Diagnosis: A Mixed Dementia Diagnosis

THIS IS POST NUMBER 100 ON THIS BLOG BEGUN DECEMBER OF 2008 WHEN MY HUSBAND WAS FIRST DIAGONOISED WITH DEMENTIA! Actually it is the 100th started--I have drafts that I haven't posted yet. Today we expect to find out what kind of dementia he has--that neurological appointment that we needed beyond the primary care doctor's 30 question diagnosis in December of 2008. Lord, go with us, as you have in the past.

6:30 AM We are up after a good night's sleep. Coffee. Anticipation. I can feel prayers of family and friends.

10:00 AM is the appointment.  DH drives to the appointment--maybe his last time driving.

Assistant Director, Clinical & Translational Sciences Institute, Nancy Teten, presented Dr. Ashok Raj's evaluation of husband's memory loss. She confirmed Vascular Dementia and Alzheimer's, A Mixed Dementia.
Dr. Raj wrote: "There is severe atrophy of the hippocampal complexes and of the amygdala bilaterally, strongly supportive of a clinical diagnosis of Alzheimer's disease."

He continues: "Vascular: There is absence of flow in the right cavernous carotid artery, indicating probably obstruction upstream somewhere in the neck. The cirle of Willis, however, appears be completely patent and the right middle and anterior cerebral arteries fill via a patent anterior communicating artery and a right posterior communicating artery. The remaining intracranial carotid arteries and the vertebral basilar system show signal void and are patent."

Nancy told my husband that until he takes a driving test at the Mortan Plant Mease Madonna Ptak Center for Alzheimer's and Memory Loss in Clearwater, he is not to drive. Dr. Raj will send them a prescription and I will call to make the appointment. If he were in an accident, an attorney might sue us for our home with his medical records. I was so impressed with Nancy's warmth and professionalism.

I then drove to lunch at Sweet Tomatoes where I had a coupon, but where he complained "Where's the beef?" I found some in the chilli soup for him.  Then I drove to Sam's where he bought a DVD and I got a few other supplies. I might fight his getting a DVD because of finances, but he just had had driving taken away from him.

He doesn't remember much of the morning, but I want to cry. He is watching his new DVD now. With Vascular Dementia he will always remember me, but with the Alzheimer's part he may not. Nancy said she was surprised that he still dresses himself, but owes that to his taking Exelon and Namenda since December of 2008. She was surprised that he is not exhibiting signs of depression. Nancy is looking at financial help for our medicines because the best place for DH to live is our home and we don't want to mortgage our home because of his expensive medicines (or lose our home due to an accident). He will have a yearly assessment at the USF Johnny Byrd Alzheimer's Institute and may or may not get it a research study. His past heart problems may keep him out of a study, Nancy said.