David Shenk Answers Your Questions About Alzheimer's

Shenk: First thing is to realize that this phase will pass. Alzheimer's is a progressive disease with many different stages. As bad as it gets in any one phase, it won't stay that way. Next, please be mindful that this is not your loved one talking - it's the disease. The Alzheimer's plaques and tangles have gotten to the parts of the brain that controls emotion and reasoning, and have created a clinical paranoia. Alzheimer's often takes gentle people and makes them temporarily violent. It takes enlightened people and turns them into racists. At that level of brain destruction, literally anything is possible.

Try not to be personally offended. Try to distract her, pacify her, do anything that gets her past that paranoid moment. At this stage in the disease, she won't remember from one moment to the next. So if you can get past this moment and put her attention on something else, you'll be past it - at least for a while.

Don't waste your time or energy trying to convince your loved one is sick with a disease. She won't understand that, and it won't help.

Question: Do you have any suggestions for caregivers who want to help ease an Alzheimer's patient who has significant anxiety as a result of his awareness of his own disease?

--Sally, Ann Arbor, MI

Shenk: You have to follow your instincts. If someone really wants to know, then it's often appropriate to share the information. But it's rarely appropriate to force the diagnosis on someone who doesn't really want to know. Depending on how far along they are, it's quite possible they will forget the news moments after you present it.

Question: Is it better to care for an Alzheimer's patient at home or is it more feasible for them to be in professional care?

--Monica, Taylorsville, KY

Shenk: Almost every Alzheimer's patient eventually needs professional care, either at home or in a facility. This nags at many caregivers, who often promise their loved one that they will never put them in a nursing home. It's important for caregivers to understand that this disease is much more powerful than they are. Everyone feels guilty for seeking outside assistance, but it simply becomes necessary.

Question: What rights are there to protect the elderly with Alzheimer's disease from people who potentially will manipulate them?

Ann, Nashville, TN

Shenk: Alzheimer's is a progressive disease. It never goes into remission. It always advances to a stage of more and more confusion. At a certain point, every patient is vulnerable to manipulation, abuse, theft, etc. The only way to protect your loved one is to personally make sure that they are protected - you or someone you trust should gain control of their finances and other important life matters.

I would urge all caregivers to work to get their loved ones to stop driving as soon as possible. It's simply not safe - for them or for others. There are all sorts of strategies for this. Unfortunately, they frequently involve deception. But in the world of Alzheimer's, deception is often required for safety and comfort.

If you feel your loved one is being unfairly manipulated by someone who you do not trust, find a lawyer. Your local Alzheimer's Association chapter might also be helpful in helping you through this situation.

Question: Can someone with Alzheimer's ever improve? What is usually the cause of death?

--Linda, Cornelius, NC

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