Describe the trajectory Alzheimer’s disease. How would you assist a family in disclosing the diagnosis to family and friends?
What will be an ideal response?
The trajectory of Alzheimer’s disease is somewhat different for each patient. However, it begins with a gradual decline of cognitive function. It is thought that it may take several years before symptoms are noticeable and may be dependent on the variable rapidity of progression as well as the person’s general health. The first symptom is loss of recent memory of events and conversations that just happened. In the early stage the older adult may or not be aware they have forgotten something, but many are very frustrated in trying to recall the “something” they forgot. Compensatory behaviors are often used to try and harness memory. Repetition of words and phrases is common as are repetitive behavioral symptoms. Family may note some mild personality changes like withdrawal or irritability even in the early stage. In the second stage deterioration is more pronounced. Some difficulty recognizing family and friends may begin. More difficulty in learning new skills may be present.
An older adult’s ability to communicate verbally is seriously compromised in the second stage of the disease. Although older adults may continue to be able to speak, sentences may not make sense or older adults may have increasing difficulty finding the right word to express an idea. Older adults also may lose their ability to dress appropriately or may become incontinent. They may have exaggerated emotional responses, such as excessive irritability, easy crying, or hallucinations. There is difficulty communicating in the second stage of the disease. The final stage is characterized by a total physical dependency – individuals forget how to eat, dress and toilet. There is no recognition of family, friends or even of self when looking in the mirror.
It is advisable that disclosures occur only after the person with diagnosis has bene able to acknowledge the disease. Predetermination of what the person wants others to know is important. Disclosures at all stages should include the person with diagnosis and preserve the wishes and values for privacy or transparency that he/she may have expressed over the course of the disease if not a lifetime.
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