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How can Mom forget me, but remember the family dog from 70 years ago?

Posted Aug 07 2010 11:51pm

The way Alzheimer’s forms in the brain, as tangles and plaque, determines how it progresses. Memories are formed in a particular order from the first memories after birth until death. When tangles and plaques begin forming in the brain, they follow the exact same order in reverse. Current memories are forgotten first, and then the forgetting moves backwards wiping out all memories like an eraser on a chalkboard.

Alzheimer’s begins in the hippocampus. As the hippocampus degrades from the formation of these tangles and plaque, the formation of new memories fails. It is not certain how long the plaques and tangles linger there, it could be 5 years, 10 or even 20. But eventually they will begin to spread and spread throughout the temporal, parietal and frontal lobes of the cerebral cortex. Eventually, sticky plaques cover most of the thinking brain. In this process tens of millions of synapses dissolve away.

In 1980 New York University neurologist Barry Reisberg realized that the Alzheimer’s-childhood analogy is not just anecdotal–that it could be measured. He documented these observations in comparison charts. The sequence of abilities gained and lost nearly perfectly mirror each other.

This chart may help to understand what is happening as the Alzheimer’s patient’s memory fails, in reverse of how it was formed in the beginning. (Copyright David Shenk, “The Forgetting”)

1-3 months     Can hold head up
2-4 months     Can smile
6-10 months  Can sit without assistance
1 Year               Can walk without Assistance
1 Year               Can speak one word
15 months       Can speak 5-6 words
2-4 years         Can control bowels/urine
4 years             Use toilet without assistance
4-5 years        Adjust bath water
4-5 years        Can dress them-self
5-7 years        Can select proper clothing
8-12 years       Can handle simple finances
12+ years        Can hold job/prepare meals,etc.

Stage            Ability Lost

1            No difficulty at all
2            Some memory issues affect job/home
3            Difficulty maintaining a job performance
4            Can no longer hold job/prepare meals/handle personal  finances
5            Can no longer select proper clothing for season
6a          Can no longer dress self
6b          Can no long adjust bath water temperature
6c          Can no longer use toilet w/out assistance
6d          Urinary incontinence
6e          Fecal incontinence
7a          Speech limited to 6 or so words per day
7b          Speech limited to 1 word
7c          Can no longer walk w/out assistance
7d          Can no longer sit up w/out assistance
7e          Can no longer smile
7f           Can no  longer hold head up

I agree that this analogy is sad and devastating to see. But I do believe that it helps to form a new understanding of what our loved ones or other sufferers of Alzheimer’s Dementia are actually going through, to understand how they feel and what they are enduring. Rather than growing angry when they don’t remember something we just said, or re-tell the same story over and over again, we can learn to be more accepting of their predicament.

As caregivers, perhaps we can strive to feel more compassion when they behave childishly rather than as the adult that we remember. By viewing our loved one as reverting back to childhood in behavior and mentalities, we can establish a more loving formula for their care, lower our own expectations for what they can do and what they can not do.

Much of this article is taken from David Shenk’s book, “The Forgetting”
I’ll be forever grateful for all the understanding it gave me while my Mom was struggling on her return to childhood–
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THE FORGETTING

With grace and precision, Shenk (Data Smog), a journalist and occasional NPR commentator, presents a lyric biography of Alzheimer’s, “a condition specific to humans and as old as humanity.” At one time, doctors thought senility, or dementia, was an inevitable fact of growing older. Now they know that Alzheimer’s is a specific, formidable disease that threatens to reach epidemic proportions within the next 50 years. The disease is named for the neurologist who, in 1906, first noticed, in the brain of an autopsied patient, the telltale plaques and tangles that strangle the brain’s neurons.

Shenk presents a thoughtful and complex rumination on many aspects of Alzheimer’s, including anecdotes about the memory loss experienced by Ronald Reagan, Ralph Waldo Emerson and E.B. White. He recounts the tales of caregivers, many of whom become clinically depressed and who, along with physicians, draw an analogy between the developing skills of a child and the decrease in cognitive ability that besets Alzheimer’s patients. {For More Information}

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