According to the National Institute on Aging, healthy brains are composed of billions of neurons and other structures that transmit volumes of information instantaneously via electrical and chemical signals. As we age, our brains shrink some, but we don’t lose many neurons. In Alzheimer’s disease, abnormally high levels of naturally occurring proteins clump between and within neurons, creating plaque that disrupts normal functioning and ultimately kills the cells.
In the early, or mild, stage of Alzheimer’s, it can be hard to see any problems, explains Christine R. Kovach, PhD, director of research at Ovation Communities in Milwaukee, Wisconsin, and editor in chief of the journal Research in Gerontological Nursing. “All of us experience senior moments where we have trouble remembering things,” she says. In normal aging, a person may forget a piece of information, but will be able to recall it later. They should have no trouble managing routine tasks, such as paying monthly bills or following an often-made recipe, though they might make occasional mistakes. In Alzheimer’s disease and other dementias, memory loss disrupts daily life. A person may forget a recently learned piece of information or ask for the same bit of information repeatedly. They may no longer be able to do routine tasks they had no trouble with before.
In a brain affected by Alzheimer’s disease, damage progresses, destroying neurons in parts of the brain responsible for language, reasoning, and social behavior. The middle stage, or moderate Alzheimer’s disease, is where caregivers tend to see the greatest changes in behavior, Dr. Kovach explains. The disease may interfere with regular daily activities or lead to dramatic changes in behavior or personality. “It’s these behavior changes that are most difficult for caregivers to manage,” Dr. Kovach says.
In the final, most severe stage of Alzheimer’s, people lose the ability to respond to their environment. They might not be able to carry on a conversation. They may be able to say words or phrases, but communicating more complex concepts like pain becomes difficult. As memory and cognitive skills decline, there may be significant personality changes and increasing reliance on help to take care of daily activities. Alzheimer’s disease is fatal because the destruction of neurons leads to lost connections between brain regions, disrupting or destroying the processes needed for basic functions such as breathing and swallowing.
Current therapies can slow down Alzheimer’s progression—but they cannot stop or reverse it. There is no cure for Alzheimer’s disease.
Other forms of dementia cause brain changes in other ways, including reduced blood flow to the brain and buildup of proteins different from those in Alzheimer’s disease. Not all forms affect memory, but most will disrupt personality, behavior, or control over the body, as well.
Opal Ruiz remembers her mother’s meltdown on their annual family vacation. The family had taken a cruise for the first time. The cabin floors all looked identical, Ruiz recalled. She herself sometimes had difficulty finding their cabin. But her mother, Joyce, who was 67 years old at the time, constantly got lost, then got angry when Ruiz offered to accompany her. “I can do it! I’m fine,” her mother insisted. At the time, Ruiz didn’t know what to make of her mother’s behavior.
Then things got worse. Ruiz answered her phone at work to hear Joyce’s panicked voice. She got scared while driving home and pulled over on the freeway. Over the next year, Ruiz would be called to leave work to look for her mother who had gotten lost while driving home. Sometimes Ruiz got calls from strangers who had driven her mother home after she panicked and pulled over. Her mother had to stop driving. She also had to end her 20-year career as a social worker. She frequently lamented, “I’m a burden. I’m too much for you.” It was exhausting reassuring her mother. Ruiz inadvertently took out her stress on her own two children, imposing more rules and restrictions.