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Health & Fitness

Alzheimer's disease

September is World Alzheimer's month. A patient, a stranger and a family try to cope with this memory-robbing disease.

Forgetfulness may be a sign of advancing years, but fading memories can often be a harbinger of Alzheimer’s disease (AD). The stranger lived with this knowledge in her role as a nurse at an assisted living facility. The last resident had passed away from AD. She carefully packed the patient’s belongings into boxes for the family. A recent photo of the patient caught her eye. The framed image on the dresser showed a large woman with pained eyes and blood-red lipstick. The color of the lipstick reminded her of the blood from the patient’s numerous falls and self-inflicted wounds. A younger version of the patient in a cherished family portrait also stood on the same dresser. The patient’s eyes were brimming with life and her dimples seemed to emphasize a crimson mouth. The stranger wrapped both photos carefully and placed the emotional ephemera into a separate box.

It was difficult to piece together the shards of an extinguished life, especially since many other patients occupied her time and energy. However, she had overheard enough information from the infrequent visits of family to imagine the last years of this particular patient. The old woman had been an accountant, a wife, a mother, a grandmother, a caregiver, a diabetic and finally a broken soul. She had been one of the (more than) five million AD sufferers in the USA. Her physician had provided guideline-recommended treatment, her son had poured over the latest advances and her husband, a blue-collar immigrant worker, had labored to understand the natural history of the disease as described in Time magazine.

He could not unravel all the complex environmental and genetic paths from DNA to dementia. He puzzled over the AD medications prescribed by her doctor. How did a cholinesterase inhibitor affect her during the mild or moderate stage of the disease? What was an N-methyl D-aspartate antagonist and how could it be used to temporarily preserve her ability to use the bathroom independently during the moderate to severe phases of this illness? He could only attempt to understand the latest scientific findings. He poured over press reports that familial AD was associated with a number of different single-gene mutations. In addition, mutated apolipoprotein E (ApoE) genes were known to be associated with an increased risk of late-onset disease. He did not understand how these genes and other factors increased the death of neurons, promoted the formation of abnormal amyloid plaques in the brain and facilitated the breakdown of tau, a protein that stabilizes the lengthy arms of neurons. He had read an article about new federal assistance to study potential disease prevention in people more likely to get AD i.e. with two ApoE4 genes. His son had heard about hopeful news that a new diabetes drug might impact AD.

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All of the news came too late for his seventy-something wife. The stranger felt helpless and hugged him. The husband picked up the photo of a younger version of his wife and smiled at the image. He would show this version to his granddaughter while teaching her about her grandmother. For the moment, he would spare her the pain that he had endured with his son. As primary caregivers, they viewed the patient’s death as a long goodbye. His granddaughter would hear about the wife that he once knew, the champion swimmer, the lover who had waltzed with him and with whom he had raised a son. He would talk about how he had arrived on US shores as a Holocaust survivor and how she had made him smile again. The stranger smiled with him. Although the old woman had died, she would live on in the memories of her husband and the next generation.

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