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Alzheimer’s: Medication and therapy are equally important

In Alzheimer’s Disease (AD), the networks of neurons break down, causing difficulties in cognition and functionality.

As he sat on the table waiting for his lunch, his wife told him that he had already eaten! She said he ate an hour ago, but he just couldn’t believe it. He did not remember eating anything. He tried to argue with her, but he just couldn’t find the right words to express himself.

Frustrated, he got up and left the table, yelling angrily. He tried to find his mobile to check the time, was it really past lunch time, but he couldn’t remember where he kept his phone. He searched everywhere.

He did not want to ask his wife as she had recently pointed out that he had become forgetful, begun taking longer than usual in making decisions and had even been getting confused about the routes he regularly took.

All these symptoms sound like this individual has a mental illness. However, the correct diagnosis for this is Alzheimer’s, a brain disease. This is a progressively neuro-degenerative condition. According to the American Psychiatric Association, Alzheimer’s can be described as a group of symptoms that lead to decline in mental functions and are severe enough to disrupt daily life. The degeneration in the brain tissue leads to symptoms that have psychological consequences.

The brain is made up of over a 100 billion cells called neurons, which connect to form a communication network, like a spider’s web.

Each group or “web” does a different job. Some are involved in seeing or hearing while others may be involved in thinking and reasoning.

In Alzheimer’s Disease (AD), these networks of neurons break down, causing difficulties in cognition and functionality.

This condition is one of the leading causes of dementia, usually from ages 65 years and above.

Alzheimer’s is a progressive disease, getting worse over time. It is divided into three stages, the early, middle and late. However, the degeneration in the brain may start nearly a decade before the actual symptoms arise.

In the initial stages, the individual can function independently, however, some symptoms that arise include difficulty in finding a word, remembering names, forgetting where things are kept and difficulty in planning and organising.

The second stage is the longest and can last for years. By this, the individual needs support and care. The symptoms may include erratic moods, forgetting personal information, difficulty in controlling bladder and bowel movements. They also experience changes in sleep patterns, experience suspicious or paranoid feelings, or even exhibit repetitive behaviours.

In the last stage, the symptoms become magnified and extreme. The patient’s ability to function and respond to the environmental stimuli reduces drastically. Communication of needs become harder, though they may say a few words, however having a conversation becomes nearly impossible. They also start having difficulty in movement, walking, sitting and eventually in swallowing. Their health starts to deteriorate, and they become vulnerable to infections. While this disease can be treated, its progression slowed down, there is no cure for the illness.

Taking the right guidance, at the right time is most important. However, a lot of people take longer to get a diagnosis, due to the stigma and denial attached to this disease. Both these impede the process of treatment.

Denial makes it hard for family to accept such changes in their loved ones. In fact, it is difficult for the patients to accept these changes in themselves. Treatment of AD starts by managing the cognitive symptoms. More often than not, the cognitive symptoms like memory loss, forgetfulness, language difficulties are shrugged off as age related, a vitamin deficiency, or even as stress. The severity of the situation is also diminished due to fear of stigma. The harder these symptoms become to ignore, the more family members or the individual themselves, become secretive about them. They are not spoken about, they are hushed, for fear that they will be judged by society, labeled, or even pitied. In some collective cultures, where a family check is important, a disease like this, can even stop couples from getting into a marriage.

Socially, individuals with Alzheimer’s may be discriminated against, excluded from various situation and even be treated as if they are incompetent. Along with social stigma, patients may also face excessive sympathy and care from family members, which may make the individual feel incapable and see themselves as “sick”.

Individuals with AD, other than facing external stigma, go through their own internal stigma. They may experience fear, general anxiety, existential anxiety and hopelessness.

In self-stigma, the patient becomes very conscious, insecure and possibly depressed. Imagine feeling uncomfortable and anxious with family and friends, imagine not being able to engage in activities that require a certain level of cognitive functioning, especially those, that one did earlier on a regular basis. There is embarrassment, and shame attached to these declining abilities. Facing these obstacles pushes the individual to feel alone and destitute.

Though the disease is not curable, mental well-being and support can help make the illness more manageable. Emotional wellness, social support and awareness will help the individual to open up and have comfortable conversations about AD.

Management of Alzheimer’s comes with medication, especially for the cognitive symptoms. Along this these, psychotherapy can greatly benefit the patient, caregiver and family.

Therapy can be a great tool in helping reduce feelings of loneliness and improve their confidence in themselves. Therapy helps the individual in working through their insecurities, their anxieties, their anger and other emotional concerns. By voicing out fears and grief, therapy can help the individual cope better, reduce negative unhelpful thoughts. For patients in later stages, you might ask the therapist about “emotion-oriented psychotherapy”, which focuses on happy thoughts and memories. It has been shown to help draw Alzheimer’s patients out of depression, which aids in improving their overall outlook on the illness and life.

In addition, caregivers also experience symptoms of burnout. Counselling for them is vital. Alzheimer’s is nearly a decade long illness. Looking after patients can be emotionally and physically depleting. Cognitive fatigue can also affect caregivers. Therapy for caregivers will help them rejuvenate, reduce stress and emotional turmoil. Family therapy is extremely essential in such cases as well. It helps families comprehend AD and the finer nuances of the illness. It guides them to behave in healthy and helpful ways with the patient and understand their own grief and denial of the situation.

Neurodegenerative disorders can happen to anyone, pharmacological support is very important, but support, care, kindness and emotional wellness drastically affect the quality of life a patient will lead.

Jyotika Aggarwal is a clinical psychologist based in Dubai