Physical Effects of Alzheimer's Disease
No one knows exactly what causes the Alzheimer's disease process to begin or why some of the normal changes associated with aging become so much more extreme and destructive in patients with the disease. We do know what happens in the brain after Alzheimer's takes hold, and about the physical and mental changes that occur over time. Although the course of Alzheimer's is not the same in every patient, symptoms seem to develop over the same general stages.
Preclinical Alzheimer's Disease
Regions of the hippocampus, which is essential to the formation of short and long-term memories, begin to atrophy ten to twenty years before there are any visible signs and symptoms. Memory loss is generally the first visible sign.
Mild Alzheimer's Disease
At this stage, the disease begins to affect the cerebral cortex, memory loss continues, and changes in other cognitive abilities emerge. Symptoms include:
- Memory loss
- Confusion about the location of familiar places
- Taking longer to accomplish normal daily tasks
- Trouble handling money and paying bills
- Poor judgment leading to bad decisions
- Loss of spontaneity and sense of initiative
- Mood and personality changes, increased anxiety
Moderate Alzheimer's Disease
At this stage, the disease has spread to areas of the cerebral cortex that control language, reasoning, sensory processing, and conscious thought. Symptoms include:
- Increasing memory loss and confusion
- Shortened attention span
- Problems recognizing friends and family members
- Difficulty with language; problems with reading, writing, working with numbers
- Difficulty organizing thoughts and thinking logically
- Inability to learn new things or to cope with new or unexpected situations
- Restlessness, agitation, anxiety, tearfulness, wandering (especially in the late afternoon or at night)
- Repetitive statements or movement, occasional muscle twitches
- Hallucinations, delusions, suspiciousness or paranoia, irritability
- Loss of impulse control (e.g., sloppy table manners, undressing at inappropriate times or places, or vulgar language)
- Perceptual-motor problems, such as trouble getting out of a chair or setting the table
Severe Alzheimer's Disease
This is the last stage of Alzheimer's. Patients cannot recognize family and loved ones or communicate in any way. Other symptoms include:
- Weight loss
- Seizures, Skin infections, difficulty swallowing
- Groaning, moaning or grunting
- Increased sleeping
- Lack of bladder and bowel control
It is important to keep your client's interests at the forefront, especially as they are coming to terms with an Alzheimer's diagnosis. A recent case held "that the early stages of Alzheimer's disease were actually a good time to write out a will, so as to allow an individual to get his or her affairs in order before the disease progressed to the point of incapacity." Rudwick v. Lloyd (Chy. No. 05-86, October 13, 2005).
In order to assure that the client has the requisite capacity, you may want to ask family members to provide a letter from the physician of the individual with impaired mental capacity stating that in the physician's opinion, the individual has sufficient capacity to execute the relevant estate planning documents. In addition, make a point of observing the family dynamics to detect any undue influence on the affected family member to change his or her existing estate plan, especially when that plan favors some family members over others. The goal is to enable individuals, even if affected by Alzheimer's disease or other mental deficiencies, to effectively plan for themselves while they still have the capacity to do so.
If your client is the child, spouse or loved one of someone suffering from Alzheimer's, he/she may be experiencing strong emotions from dealing with the day-to-day struggles of the disease. According to C.J. Farran, in Loss, Mourning and Suffering: The On-going Funeral of Dementia, it is common for family members and particularly the caregiver to experience feelings of loss. These feelings will likely involve the natural phases of grieving, such as denial, anger, guilt, physical symptoms and eventually acceptance.
The following tips can help your client, whether the client is the caregiver or the patient, find his/her way to peace of mind with regard to dealing with Alzheimer's:
- Become informed: There are hundreds of good books and resources. See The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer's disease, Related Dementing Illnesses, and Memory Loss in Later Life by Nancy L. Mace and Peter V. Rabins.
- Contact the nearest chapter of the Alzheimer's Association.
- Consider joining a support group.
- Discuss the situation and your feelings: Don't hesitate to talk openly with your loved ones about the situation. It is also important to discuss issues such as power of attorney when those discussions are still possible and will be meaningful.
Also discuss your feelings with other family members and friends who you can rely on for support.
- Schedule a doctor's appointment: When a loved one is experiencing memory loss, it is important to see a doctor sooner rather than later to get an accurate diagnosis and to obtain treatments that will delay some of the more severe symptoms.
- Talk to your doctor about other matters: Discuss health care treatment wishes and end-of-life matters.
- Meet with an experienced Elder Law attorney: It is important that the wishes of the patient be documented and that the proper planning is put into place. You may want to discuss advanced medical directives, powers of attorney, revising wills and trusts, changing property titles, strategies for financial or other gifts, and long term care strategies.