The 'A's of Alzheimer's
We all associate Alzheimer’s disease and dementia with memory loss, but unfortunately it is much more than that. As we continue to recognize Alzheimer’s and Brain Awareness month, let’s take a deeper dive. There are 4 ‘A’s to help you remember common symptoms, plus we’ll review a few more ‘A’s for good measure. Some may experience all of these symptoms in dementia, others may not, or they may see them at different times throughout the disease. But being aware of symptoms to look for will help you be an ‘A’ student – and caregiver!
Amnesia is probably the first symptom we associate with Alzheimer’s disease, and often the first to be recognized – loss of memory. We all have two types of memory: short-term and long-term. Because these memories are stored in different regions of the brain, they can be affected at different points in the disease. Short-term memory is most commonly affected first. This is why you’ll see your loved one ask the same questions over and over, such as “where are we going?” With short-term memory damaged, you may have told them you’re going to the grocery store ten times, but your loved one is unable to retain the memory of that conversation. (They’re really not asking the question again just to annoy you!)
You may have to be a language lover to be familiar with the word “Aphasia,” but vocabulary lessons aside, aphasia is the loss of ability to use language. You can also think of this symptom as loss of communication skills. There are two types of aphasia, based on if the person is the one doing the communicating, or the one receiving the communication. Expressive aphasia is the loss of ability to speak and write; basically the loss of ability to express yourself. You may notice your loved one having trouble finding the right word. Or they may use an elaborate description for an object to cover up that they can’t remember the object’s name. Receptive aphasia is a loss of ability to understand spoken words or what they read. They have trouble processing language that is received. Keep an eye on your loved one. Some individuals may still nod along with the conversation to pretend they understand. Others may withdraw from social settings more frequently if conversation is becoming hard to follow.
As we continue with the ‘A’s, don’t get hung up on the vocabulary – apraxia is probably another new word for most of us. The words are tricky, but the concept is simpler. Apraxia is the loss of motor skills. Fine motor skills, or sophisticated job-related tasks will probably be the first skills to be lost. The brain is having trouble telling your body how to carry out purposeful movement, so more intricate fine motor skills will often be lost first. Eventually you may see this loss of motor skills affecting your loved one’s activities of daily living. They might find it hard to brush their teeth, fasten a button, or tie their shoes. The loss of motor skills can also affect coordination, such as coordinating hand, arm, and leg movements together. This is why you may also see difficulty driving at first, or even with walking or eating later on in the disease.
Another new word for another familiar concept: the 5 senses. Agnosia is the loss of ability to recognize things through your senses: sight, sound, taste, touch, and smell. With these changes in the brain, it becomes harder for your loved one to process what they’re seeing or hearing. You’ll see this manifest in not recognizing (what should be) familiar people or objects. While forgetting what a pencil is used for can be harmless, this is actually an important symptom to watch for with your loved one. Safety can become a concern if your loved one can’t figure out which nobs turn on the stove versus the cooktop burners. For some, agnosia can progress to being unable to process internal information as well, such as perceiving pain from touching that hot burner they turned on. Others may have trouble recognizing a full bladder or a chest pain. If your loved one is experiencing a lot of difficultly processing information from their senses, be very careful about their surroundings to keep them safe!
Extra credit ‘A’s
The first four ‘A’s represent many of the most common symptoms your loved one may experience, but again, everyone is different! While (slightly) less common, there are 3 additional ‘A’s to be aware of. Anosognosia (the last new word!) affects your ability to recognize change. The part of the brain that helps reasoning is damaged, and they may not understand why they have cognitive problems – or more commonly – might not understand that they have cognitive problems at all! Altered perception, while similar to agnosia, is actually misinterpreting information from the senses. For many this will manifest as difficulty with depth perception. For example, if flooring is all the same color, it might be difficult for your loved one to see there is a step down, or judge how high of a step it is. Apathy is the last ‘A’ on the list. While many of us may have experienced this during a particularly long lecture or a dry business meeting, with dementia you’ll see it as the loss of ability to take initiative. Your loved one may have trouble beginning activities, or they might need prompting or cues about where to start or what to do next. Apathy can be why many see loved ones sit in front of the TV all day – they’re not sure how to begin a new task or activity. Just don’t let apathy get the best of you!
That’s a lot of ‘A’s to remember, but whether you remember the words or not, understanding the symptoms will help make you a better caregiver or Alzheimer’s advocate!
Want to learn more?
Insight offers free education programs regularly throughout the month on a range of topics from Dementia 101 to more specialized caregiving skills. Check out our event calendar to see what’s coming up!
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