Notes from an emergency room doctor: "Hello,"
the voice on the other end of the phone whispered
But I knew immediately who it was. "Hello,
"Your father doesn't know I'm calling,"
she said still softly.
"What's the matter?" I asked apprehensively.
"Your father is not thinking right,"
my mother went on. "He's getting senile."
My father is seventy-seven, somewhat cantankerous
at times, but still active. That word "senile"
switched my thoughts to nursing homes, and wheelchairs,
and spoon feedings. A friend had just related
the story of his own father who had recently developed
Alzheimer's. One morning his father went out walking
with his grandson. A few hours later, he came
home without him. He just forgot he had taken
the little boy along. Fortunately, that incident
had an uneventful outcome. The child was found.
But the "old man" was upset by his lapse.
And his son was equally distressed. Knowing that
your father has become as dependent as your child
is an agonizing threshold event in life. Had my
time come to deal with this difficult and all
too common illness that transforms the lives of
the elderly that suffer from it and their families?
"He's not thinking right," is often
the first and only way family can describe the
syndrome of dementia that has overcome a loved
one. Dementia usually results from a degeneration
of the cerebral cortex, the thinking part of the
brain. There are some treatable forms of dementia
like subdural hematomas, cancer, tuberculosis,
anemias, vitamin deficiencies, thyroid disorders,
chronic infections, and diabetes. But once the
treatable dementias have been ruled out, the diagnosis
of exclusion is called senility or Alzheimer's
Alzheimer's disease (AD) is a progressive, severe
atrophy of the entire brain, particularly the
frontal cortex, which not only effects thinking
but a patient's emotional control. AD has a relatively
subtle and early onset, between the ages of 40
and 60, and then progresses steadily to total
impairment usually within 5 to 15 years.
Anatomically, senile dementia is very similar
to Alzheimer's. Some experts think it is just
a milder form of AD with a later onset.
In its early stages, someone with dementia may
exhibit little more than some anxiety or depression
as they subtly try to cope with increased problems
with memory or comprehension. As these deficits
progress with more obvious loss of memory and
defects in judgment, anxiety and depression also
increase along with occasional eruptions of volatile
There is no cure for AD. Until recently, physicians
could only treat its secondary symptoms. Agitation,
delusions, hallucinations, and paranoia were treated
with antipsychotic medications. Anxiety was treated
with drugs like Xanax or Ativan. Depression was
treated with a myriad of antidepressants. And
there are several drugs now that help slow the
progression of the disease – Namenda, Aricept,
Exelon, and others. But there is no cure. There
is no evidence that any drug changes the underlying
disease process at all.
Because senility and AD are so insidious in
their progression and because they are so associated
with the process of aging, many don't think of
these ailments as a major health issue. But 4
million Americans have Alzheimer's. It is the
nation's third most expensive disease, after heart
disease and cancer, costing more than $90 billion
a year. Worse still, two-thirds of the costs of
caring for Alzheimer's patients are indirect,
often involving round-the-clock care, and lost
productivity for both the patient and the patient's
caring family, costs hardly ever covered by insurance.
"How is dad not thinking right?" I
asked my mother. "Does he get lost? Or forget
what he's doing?"
"No," she answered. "He forgets
to shut off the lights and lock the doors at night."
"My God," I laughed. "Using that
criteria, I'm senile. Most everybody I know is
"Well," my mother went on, "I
have to stay up now until he goes to sleep. I
used to go to sleep first but I can't anymore."
"Mom, even if he is a little senile, there's
not much you can do about it. So, go to sleep."
"All right," my mother responded,
unconvinced. "Good night."
"Mom!" I caught her before she hung
up. "And don't worry." Afterall, I thought,
that's my job. Then I added, "And don't forget
to lock the door and shut off the lights."