Q. I recently read about a disturbing case where a woman left her job to help care for her father who had early-onset Alzheimer’s. But despite her loving gesture her dad one day turned against her and almost killed her. What would drive a parent to do that?”
Let’s get first things right. Dr Aloysius Alzheimer was a German psychiatrist who was born on 14th June 1864. He died in 1915 and gave the name to the disease that is now estimated to rank sixth as the cause of death in America.
Experts estimate that it is now moving rapidly and within the next few decades, will rank third with only heart disease and cancer ahead. For this reason alone, Alzheimer’s disease has been described as the medical public health emergency of our time, and billions of dollars have been put aside, to understand and hopefully find a cure for this neurodegenerative condition.
It causes severe irreversible damage to brain cells. Memory loss is perhaps the first and most obvious sign of this condition, which is also called presenile dementia.
This latter name captures the fact that the condition often manifests in one’s 60s, long before the expected onset of senile dementia. It is enough for us to state here that the anatomical changes that take place in the brain include its shrinkage.
A few years ago, we saw a senior citizen at the request of his lawyer. His daughter by his first wife had contested his donation of the power of attorney to the first daughter of his second wife. He had no living sons, two of them having died in a road accident, blamed by some on their stepmother. The family dynamic was such that there was much hostility.
When seen, the old man was well groomed, wore a suit and tie, and seemed physically well. He had mild well controlled diabetes and hypertension and in conversation was lucid and coherent.
Asked why he had presented himself to the doctor, his answer was as simple as it was clear. He said that a well respected neurologist had examined him and told him that he was showing mild but definite features of Alzheimer’s disease.
The medical report that he brought along stated that at the age of 69, he had been showing features of forgetfulness for the past three years. At first it was small things.
He would lose his car keys often, and needed his wife to remind him of the simplest of things, e.g. appointment he had made with his pastor. On the day he was sent to the neurologist, he had parked his car in the city centre and could not find it later in the day.
He reported the matter to the police and the next day the car was found at the exact spot where he had left it. The young man remembered the old man, but more importantly the fact that he was given a very large tip, as though the man could not tell exactly how much money he had given him just for watching over the car as he did his job.
Although the man had lost memory for recent events (e.g. where he had parked his car), his memory for remote events was intact. This latter fact confused the family (but not the doctors) because they could not understand how he knew where all his plots, houses and shares were, and he could not find his car that he had just parked!
In this stage of Alzheimer’s disease, the man had received good advice from his neurologist who had told him that in time, his memory and ability to look after his personal affairs would go away steadily, and his language and vocabulary would also deteriorate, as would his physical and mental abilities.
He was also told of the possibility that he could develop a psychological illness in which context he could become excessively suspicious even of his close relatives (This might be what happened to your father!).
Armed with all the above information and before he had deteriorated (like your father) our new patient had gone to his lawyer and the power of attorney (now in dispute) was created.
Our report caused even more confusion because on the one hand we were in full agreement with the diagnosis of the neurologist that this man had Alzheimer’s disease, while on the other hand we held the opinion that the man had the capacity to understand the need, effect and benefit of donating the power of attorney to his chosen daughter.
In the case of our patient, the presentation of the patient was early and systems could be put in place to manage his affairs. You on the other hand are dealing with very late stage Alzheimer’s.