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Alzheimer’s Disease

 INSHAPE NEWS MIND MATTERS

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Peter Walker – Clinical Psychologist

Alzheimer’s disease can affect people from their 30’s but more commonly affects those in their 80’s. As it progresses it can become disabling and distressing for the effected individual. Often overlooked are the implications of this condition for carers. Let’s consider a real life example so we can understand this better.

Stan, Peggy and Alzheimer’s

Stan and Peggy’s marriage spans over 64 years. They met and courted just before the Second World War, and they have weathered the trials and tribulations of the second half of the 20th Century. Their relationship was fairly traditional. Stan was the breadwinner and drove buses and also made a small amount as a handyman in the neighbourhood. Peggy’s role was firmly in the home, and she was the organiser, cook, decorator and an essential social support for her family and community.

About three years ago, Stan noticed some subtle changes in his relationship with Peggy. He noted that they were becoming late for functions, they’d forgotten to send birthday cards on a few occasions, and he recognised that Peggy appeared vague and perplexed from time-to-time. As a result of these changes, Stan and Peggy fought more often. Stan accused Peggy of being careless and irresponsible. Stan was a proud man and felt embarrassed that their behaviour as a couple had drawn attention within their community.

Stan discussed his concerns with his adult children who then arranged for Peggy’s assessment by a local Aged Care Specialist. The specialist very quickly concluded that Peggy was experiencing the early stages of Alzheimer’s disease. The family were given a pamphlet outlining the symptoms and then were hurried out. Although this clarified matters to some degree, it left Stan confused as to what to do and what the future held for him and his wife.

Alzheimer’s Disease and Relationships

The story described above is a common scenario, especially for partners of those affected by Alzheimer’s disease, a common form of dementia characterised by memory loss, confusion, lack of interest and emotional liability. In Stan and Peggy’s case it reversed their roles, Stan had to become the organiser, cook and cleaner.  He gradually lost the emotional support of his wife, which he had taken for granted, and as Peggy’s condition declined, Stan lost his best friend.

Alzheimer’s Support

Although insufficient, there is some practical support and information available for those caring for someone with Alzheimer’s disease. Interventions to better manage behaviour in the home, respite and professional support are accessible in the community. However, due to the busy nature of the medical system, an elderly carer can be left confused and lost in the complexity. It becomes the obligation of those who support carers, such as their family and friends, to encourage them to keep pressing their GP’s, medical specialists, community nurses and local MP’s for more support.

 PeterWalkerPeter Walker has over 12 years experience working as a clinical psychologist. He has worked in both public and private practice, having specialised in complex presentations. He established his private practice, Peter Walker & Associates, clinical psychologists, in 2002 as a service to provide psychological treatments for those experiencing difficulties with anxiety, depression and couples in distress. In addition, the practice was relatively unique in that it offered specialised treatments for those experiencing psychotic disorders and bipolar disorder. At the time Peter Walker & Associates was established the development of psychological treatments for these conditions was in its infancy and Peter was considered an innovator in this field. Peter provides clinical supervision for mental health practitioners, is a sought after presenter and has experience providing expert opinion in the media. In recognition of his experience treating mood disorders he has been asked to take on a role at the Black Dog Institute in 2013.

Jay Spence – Clinical Psychologist and PhD Candidate

Alzheimer’s disease (AD) is the most common form of dementia. Simply put, dementia is the term for when someone’s intellectual ability starts to worsen for reasons that aren’t just because of normal ageing. For example, as we age it is normal for memory to be affected. Occasionally forgetting things, misplacing things, forgetting appointments or being absent-minded at times is normal. However, things like confusion or distress in unfamiliar situations (that wouldn’t have caused distress in the past), or completely forgetting that memory lapses had occurred, can be early signs of AD. AD is diagnosed by tests of intellectual functioning and/or a brain scan. What many people may not know is that there is no clear evidence showing that anything can prevent AD despite the dozens of products that claim to do so.

Alzheimer’s Research and Natural Therapies

Gingko Biloba has been given an “A” rating by the Mayo Clinic who say that it “benefits people with early-stage Alzheimer’s disease and multi-infarct dementia” although they admit that “well-designed research comparing ginkgo to prescription drug therapies is needed.”

In 2008, a study (http://www.ncbi.nlm.nih.gov/pubmed/19017911) of 3,069 people aged over 75 was conducted to determine the effects of gingko on dementia. They got two doses of gingko a day or two doses of a placebo. They were assessed every six months over several years to see the effects and the researchers were very careful to make sure that anyone who showed signs of decline received proper tests that were reviewed by expert scientists and doctors. In the end, there was absolutely no difference between the ginkgo group and the placebo group for dementia onset. In other words, gingko won’t stop dementia any more than taking a sugar pill.

Although, there is no definitive evidence that AD can is preventable as yet. There is evidence to show that medications can help manage the symptoms once it begins. Two important research studies demonstrate this. In the first study (http://www.ncbi.nlm.nih.gov/pubmed/17035647?dopt=Abstract), 421 people with bad symptoms of AD-like delusions and aggression received one of three medications or a placebo. After nine months they reported that there wasn’t much difference between the treatments at all. However, one reason this happened was a lot of people stopped taking the medication or switched medication. This fact is important because another study (http://www.ncbi.nlm.nih.gov/pubmed/22397651?dopt=Abstract) showed that when people stayed on the medication, their symptoms got much better.

Thus, you might be better off saving wasted money and energy trying to prevent AD. Instead, investing in the treatments that do have research support in case AD does affect you or your family.

Jay SpenceJay Spence is a Clinical Psychologist and PhD candidate who specialises in adult and adolescent mental health. He was joint recipient of the Gold Prize at the Australian and New Zealand Mental Health Service Achievement Awards (2010) and of the St Vincent’s Health Australia National Invention and Innovation Award (2010) and was the recipient of the 2011 New South Wales Institute of Psychiatry Fellowship. He has published numerous papers on the treatment of post-traumatic stress, social phobia, and panic, as well as generalized anxiety and transdiagnostic anxiety processes. He held a conjoint lecturer position at the University of New South Wales from 2009 to 2011, lecturing on the treatment of anxiety and depression. He is currently completing a PhD on internet-based interventions for post-traumatic stress disorder (PTSD). He is developing these treatments as part of the Centre for Emotional Health at Macquarie University because PTSD is the most prevalent anxiety disorder in Australia. However, many people do not have access to effective treatments. He sees patients in private practice in Darlinghurst, Sydney.

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