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Alzheimer's Disease Patients Can Deceive Outsiders with Their Behavior

Posted Nov 18 2010 7:57pm

The ability to act differently for others, shows that Alzheimer’s disease patients maintain social skills.....
By Max Wallack
Alzheimer's Reading Room

One of the hardest things about caring for an Alzheimer’s patient can be the fact that there is frequently a feeling that no one else really knows what the caregiver is going through.

Adding to this frustration, is the ability that many Alzheimer’s patients have to “pull themselves together” and present a seemingly “normal” front to other people, even to their physicians. Our family experienced this quite often while caring for Great Grams who suffered from Alzheimer's disease.

Great Grams would be extremely paranoid when she knew she was going to her doctor. Of course, she was afraid we were going to "put her away" (nursing home), so her behavior would be horrible.

Once at the doctor's office, she could hold an intelligent conversation. She appeared pleasant. If he asked questions she didn't know, she could even make excuses. For example, "I never really paid attention to the name of this hospital". Great Grams even tried to change the subject, like pointing out the doctor's pictures of his family and telling him how cute his kids were.

When my aunt and uncle called on the phone, Great Grams talked completely normally. Anyone who didn't understand her condition could easily conclude there was nothing wrong with her. Sometimes they assume all is going very well based on these conversations.

Often when we went to visit someone, Great Grams held normal conversations, way into her illness. I remember, on one of her later hospitalizations, hearing her tell an aide how beautiful she was and how pretty her sweater was -- then telling us that the aide was a horrible person plotting against her.

For much of her time in Alzheimer's, Great Grams could travel and be fine on a trip. However, total breakdowns seemed to happen when we returned home. You would think that returning to the familiar would have made things better, but they always made things worse. Understanding and accepting Alzheimer's behavior is very difficult. Even when you see it over and over.

I asked a doctor about this once, and he answered that sometimes Alzheimer's patients can "rally the forces", meaning they can work exhaustively at trying to "keep up" and interact. This can continue until late stages of the disease. Alzheimer's patients are somehow successful at continuing to do this. HOWEVER, this exertion of attention is SO EXHAUSTING to Alzheimer’s patients, that they basically are having a breakdown afterwards.

Since Alzheimer's is really a memory problem and not a social problem for most of its course, patients often realize that they are having a major problem, and they use their social skills to cover it up. But, this is so tiring, that it uses up all their resources, and those who are with them afterwards, often see the sad effects of these exhausting efforts.

Great Grams had most of her hospitalization-requiring breakdowns after our returns from vacations. She had used up all her reserves. She had some good times on those vacations, but there was certainly a cost for her.

Only very, very late in her illness, did Great Grams begin to lose the ability to "cover it up". Only on a visit a few months before her death, did she react abnormally when her son visited, not recognizing him and accusing him of preposterous things. Only on her last outpatient visit to her doctor, did she basically fall asleep for most of the visit.

Only when Great Grams had progressed to the final stages of Alzheimer's was she no longer able to present a normal-appearing front to others -- outsiders.

The ability to act differently for others, shows that the Alzheimer’s patient maintains social skills. When with the caregiver alone Alzheimer's patients feels safe, and don't have to exhaust themselves to present themselves as they would like to be seen.

Insight and Advice

Max Wallack is a student at Boston University Academy. His great grandmother, Gertrude, suffered from Alzheimer's disease. Max is the founder of PUZZLES TO REMEMBER. PTR is a project that provides puzzles to nursing homes and veterans institutions that care for Alzheimer's and dementia patients.

Original content Max Wallack, the Alzheimer's Reading Room
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