I was devastated when my aunt blankly stared at me and asked, “Who are you?” She had been afflicted with Alzheimer’s disease.

Alzheimer’s disease is a brain disorder named for German physician Alois Alzheimer who first described it in 1906. It is the most common form of dementia — a general term for the loss of memory and other intellectual abilities serious enough to interfere with daily life. The disease usually begins after age 60, but it is not a normal part of ageing.

Alzheimer’s destroys brain cells, causing problems with memory, thinking and behaviour. It begins slowly, first affecting parts of the brain that control thought, memory and language. Those affected may have trouble remembering things that happened recently or names of people they know.

As time passes, symptoms worsen. They may not recognise family members and may have trouble speaking, reading or writing. They may forget how to care for themselves, how to brush their teeth or comb their hair. Later on, they may become anxious or aggressive, or wander away from home. Eventually, they need total care.

The brain has billions of nerve cells, each communicating with many others in networks. These networks have special jobs helping us to see, hear, smell, move, think, learn, and remember. The brains of people with Alzheimer’s have two abnormal structures called plaques and tangles, which damage and kill nerve cells. Plaques contain deposits of a protein fragment called beta-amyloid, which build up between nerve cells. Tangles, which form inside dying cells, are twisted fibres of another protein called tau. Plaques and tangles block communication between nerve cells and disrupt activities essential for the survival of the cells.

Word to caregivers

In the early stages, a person afflicted with Alzheimer’s may still be able to perform daily tasks, allowing them to live and function independently. However, as the disease progresses, these abilities rapidly decline.

The person may react with frustration, agitation and aggression when their once familiar tasks become difficult. The following suggestions may help to ease caregiver and patient frustration:

Establish a schedule

This helps to make the day more predictable and less confusing. For example, determine the time of day when your parent is most calm and agreeable and schedule the most difficult tasks, such as bathing, for that period.

Allow him or her to help: Allow your mother to do as much as possible with the least amount of assistance. Perhaps she can dress herself if you lay out her clothes in the order they should be worn.

Reduce distractions: Doing this at mealtimes or during conversations can allow your charge to better focus on one thing at a time.

Allow for more time. Things will take longer than normal. Schedule more time to complete even simple tasks. Provide step-by-step instructions.

Create a safe environment

Alzheimer’s disease impairs judgement and problem-solving skills, increasing the risk of injury. The home environment needs to be modified to reduce danger.

* Avoid throw rugs, extension cords and any clutter that can cause your parent to trip and fall. Install handrails in the shower, night lights and gates at stairwells to prevent falls.

* Install locks on cabinets that contain medicine, alcohol, guns, chemicals, cleaning agents, dangerous utensils, and tools, and hide the keys.

* Control access to stoves, matches or lighters. Householders with gas stoves may have to turn off the cylinder.

Wandering

Alzheimer’s disease can literally erase a person’s memory of once-familiar surroundings. The disease can also make adaptation to new surroundings very difficult. Consequently, people with Alzheimer’s sometimes wander away from their homes for a variety of reasons. They may be searching for something, or trying to get away from a noisy or confusing environment. Some may even be reliving the past.

For example, a man who tries to leave home at 7:00 am may believe that he is going to work. A planned activity at that hour may provide a distraction. A safe place for walking, say a trail in the backyard, may be helpful for wanderers. Alarms and locks can also aid in keeping track of wanderers, for example, warning bells and sliding bolt locks on doors and childproof covers on doorknobs. People with Alzheimer’s disease should also wear identification bracelets.

Dr Jacqueline E Campbell is a university lecturer and family physician. She is the author of the book A patient’s guide to the treatment of diabetes mellitus.