One of the definitions of Alzheimer’s Disease is that it is normal to forget where you put your keys. It is not normal to find your keys and not know what they’re for.
My father died of Alzheimer’s Disease (AD, also known as SDAT – Senile Dementia of the Alzheimer’s Type) at age 78. He recognized no one around him. My mom, on the other hand, died at age 93. She not only knew who I was, but knew that, since it was Monday, it was my day off and that was why I could be with her all day. The fact that she was dying went unsaid. She died just as it got dark that evening.
How does one die of Alzheimer’s Disease? Forgetfulness goes beyond just “what are these things for?” to forgetting how to chew and swallow. The immediate cause may be dehydration or malnutrition but the ultimate cause is the disease. My father’s autopsy report mentioned cardiac arrest and multiple organ system failure…duh. He died when his heart stopped beating, not really because it stopped beating. He could have remained alive longer with IV fluids and a feeding tube, but to what end? He had made that decision long before, as have I. If you have not done it yet, write an Advance Directive – a document that specifies what care you want (and don’t want) in the event of a terminal condition. I know – you don’t want to think about that. Death happens to other people. Guess what? It happens to all of us. But you’re not old. Guess what? Not everyone dies of “old age”. Ultimately, there is one terminal condition in life – it is birth.
Alzheimer’s is only definitively diagnosed after death, from examining the brain. In his case, they even left that out until we demanded an addendum to the report. They had examined his brain but neglected to include those findings in the report. With research, we may be able to diagnose the disease short of death; maybe even treat, cure, or prevent it.
An aside: you may notice that “cure” is a rarity in medical science. We tend to “treat” disease by administering medications to control symptoms – medications that often must be taken for life and at great cost. We don’t “cure” a whole lot of diseases. The cynical among us may say that there is little profit in cure and a lot of profit in lifelong treatment.
Prevention of SDAT may well hinge on a lot of the same factors as many diseases – eat well, sleep well, stay physically active, control blood pressure (and have the right genes).
The PBS series Nova produced a documentary on the WRAP (Wisconsin Registry for Alzheimer’s Prevention) study. It is an hour well worth your time. There were damp cheeks in the program, on both sides of the screen.
The project enrolls the children of people diagnosed with AD (and a control group of people without a familial history) and follows them longitudinally. Every few years, participants complete a lengthy questionnaire (with another completed about them by someone who knows them well) and complete a lengthy battery of neurocognitive tests. Additional optional studies include MRI, functional MRI, and PET scans; lumbar punctures; and treadmill testing.
As a test subject, some of this is difficult, as it involves testing to failure. How long a digit span can you recite backward after hearing it once? You get longer and longer spans until you fail. How steeply can you walk up a treadmill at a set speed? You go until you can’t.
Can we see changes in brain structure and function before one develops symptoms of the disease? Does cardiorespiratory fitness delay or prevent onset of disease? Can we see biomarkers of disease in the brain or the cerebrospinal fluid prior to recognizable disease onset? If so, can we address those markers and influence the disease path? These are a few of the questions the study aims to answer.
What’s it to you? Research shows the children of those with AD are more likely to contract it themselves. My father, his brother, sister, and mother all died of AD. On my maternal side, I have questions about a couple of aunts. But you’re not me. According to the Alzheimer’s Association, “1 in 3 seniors dies with Alzheimer’s or another dementia. It kills more than breast cancer and prostate cancer combined.” The longer you live, the greater are your chances of developing Alzheimer’s Disease. If you are a woman or person of color, your risk may be higher than if you are a white male. Per 2022 Alzheimer’s Disease Facts and Figures “Structural racism pervades many aspects of life that may directly or indirectly alter dementia risk.”
Maybe a coast-to-coast bike ride will help prevent Alzheimer’s Disease. That would be icing on the cake. For today, I’ll ride my bike through the snow to the library.
It is snowing. It is the day that US taxes are due. Does that have anything to do with why I am writing this today? It was in 1716 that Christopher Bullock wrote “Tis impossible to be sure of any thing but Death and Taxes” (though for the uber-wealthy, even taxes are not a sure thing).