NBC News: A dementia that rivals Alzheimer’s strikes before age 65

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This is the news special that was on NBC News on 13 June 2013. You can find the article I’ve pasted in below at this link.

Video: Frontotemporal dementia affects a different area of the brain than Alzheimer’s, destroying the frontal lobes and spurring big personality changes. NBC’s Robert Bazell reports.

Just two years ago, Barbara Whitmarsh was a woman who seemed to have it all. She was a highly regarded scientist at the National Institutes of Health. Married for 30 years, she’d raised six children with her beloved husband, John.

But then John Whitmarsh started to notice some disturbing changes in his wife, now 62. It was as if the woman he’d married and lived with all that time was slowly and inexorably fading away.

“Her ability to feel empathy, her personality, it just disappeared over a period of time,” John said. “I would ask her, ‘Is there anything wrong?’ and she would say, ‘No, I love you and everything’s fine,’ but she wasn’t there. And she said it in that flat way.”

A scientist himself, Whitmarsh knew there was, indeed, something wrong. And he was worried. He asked his wife to see a psychiatrist who eventually diagnosed her with frontotemporal dementia or FTD.

It’s a dementia that generally strikes at an earlier age than Alzheimer’s disease. And its symptoms are different – at least in the beginning – from Alzheimer’s because it originates in a different part of the brain.

It’s also a disease that until very recently doctors thought was rare — but that view is changing.

“We’ve begun to realize that frontotemporal dementia is actually more common than Alzheimer’s disease in people with degenerative disorders under the age of 60,” said Dr. Bruce Miller, director of the Memory and Aging Center at the University of California, San Francisco.

The Alzheimer’s Association estimates that in people younger than age 65, FTD may account for up to 20 percent to 50 percent of dementia cases.

While Alzheimer’s can eventually lead to behavior problems, it starts with a deterioration of memory as neurons in the hippocampus are destroyed. FTD starts with behavior problems caused by the death of nerve cells in the frontal lobes, then spreads to other areas of the brain, leading to fading memory. As the diseases progress, they become more and more difficult to tell apart.

A key symptom of FTD is a loss of inhibition since the frontal lobes are responsible for judgment, decision making and self-control. Before her illness Whitmarsh watched her weight closely. In just a year she has gained 30 pounds.

Because those early symptoms can be mistaken for psychiatric illnesses, people with FTD are often misdiagnosed, Miller said.

For that to change there will need to be “a paradigm shift in our society,” he added.

“I think traditionally people have thought about behavioral symptoms such as loss of empathy for other people, addiction later in life, disinhibition, as not having a neurological origin. I think that when people begin to realize that when someone in their 50s or 60s suddenly loses empathy for others, becomes disinhibited, becomes profoundly apathetic, begins to overeat, frontotemporal dementia needs to be suspected.”

“It’s a tragic problem because often the first manifestations of the disease are bad judgments and disruption of the family infrastructure happens,” Miller said.

For Barbara Whitmarsh, the brain damage due to FTD has meant living in a locked nursing home, where she moves compulsively and constantly.

As the disease has progressed it also has robbed her of her memory. She seldom recognizes her husband or their children and she rarely speaks.

As with Alzheimer’s disease and other dementias, there is currently no treatment for FTD.

For more information on FTD, please visit The Association for Frontotemporal Degeneration: http://www.theaftd.org/

I had forgotten Mom’s laugh.

Mom’s been having some amazing days. It’s inexplicable. Comes with the territory, we guess. And I got there on Monday and went to visit her in the bedroom and she laughed. I was actually startled. Hadn’t heard her laugh in so long that I had forgotten the sound.

Dad reported yesterday that she was making serious effort to talk and communicating fairly well. It’s baffling. Why now? What’s changed? Is it the seizure medication, helping somewhat? Dad said she was even using her fork with very little help.

I gave her one dose of PristiQ one day last week, but it was only for one day. It could not have had that much impact.

We have to roll with it, take the good days when they come because there are quite a mediocre days and some number of really bad days. But these have been really awesome days.

Part of me is completely numb when it comes to Mom, so I was actually surprised that I felt something when I heard her laugh. It’s hard when she’s gone and gone and gone and you get used to her being gone and then in a moment you get a glimpse of who she used to be. And some memories come back. I don’t like to think about it too much because here, now, I’m crying at the thought of her loss, inch by inch.

See, when you lose someone inch by inch, your memories get replaced by this new person that changes and becomes someone different every day. Perhaps it is like that when you raise a child – this adult in front of you is a greater part of your memories than the toddler they were. But unlike the child-adult memory growth, these memory process replaces good memories with bad, painful, difficult memories. Well, some of them.

So it goes.

We’re having a hard day

Mom’s having a hard day today. She had a seizure this morning in the bathroom with Dad. And now with me, she’s unable to stand, let alone walk. She’s not focusing. Her eyes will open, but she’s in a dull haze. Dad reports that it’s been about two weeks since she had a decent BM, although there have been little bits. So we figure her system is going toxic, as she usually displays these symptoms before a giant BM comes out. We keep trying to change her diet so that she’ll have lots of fiber and liquids so that her BMs come out regularly, but we haven’t succeeded yet. And she spends so much time in bed that things…move slowly.

It’s Dad’s birthday today. He’s turning 70. Sadness: I didn’t buy a card-from-Mom this year. I thought I might try and then maybe she could sign with an x or something, but she’s not even responsive enough for that.

I made him a cake : Duncan Hines Triple Chocolate Decadent Cake mix. I added minced pecans to the batter. Then, when I put the cake together, I put sliced fresh strawberries and buttercream frosting in the middle. The outside of the cake has classic chocolate and milk chocolate frosting. And then more pecans on top.

Mom is lucid but depressed…

I gave her a bite of brownie this morning – put it in her hand and she ate it – and then later she said quite clearly: “more than one.” She wanted more! I brought her more.

After the doctor’s visit on Monday, she’s been seriously depressed. On Monday night she actually told Dad, clear as day, “I’m mad at you.”

I’ll bet she heard that whole DNR conversation, too. The APRN often acts like Mom’s not even there, can’t hear her. But that’s not the case at all. The APRN spends a lot of her time working at group homes and other locations with mentally-challenged patients. She doesn’t get that Mom can understand her. No wonder Mom’s in bad shape emotionally.

I think I am going to cut that damn DNR bracelet off of her. She doesn’t go anywhere except here and if she goes anywhere, she’s with Dad. We put the bracelet somewhere where it is not a constant reminder to her that she’s about to die. Which she isn’t.

But she smiled when she saw me. That makes it harder to move away. I am a big part of this life here. I like to blame Dad for things but if I want things changed it should be me that changes them. I often think I have no choices when all along I am making choices that make me miserable.

 

Bottom line is I have to stop doing the physical caregiving for my mother and just go back to being her daughter.

Signing a DNR for Mom. Really? Already?

Mom’s still healthy. Well, comparatively speaking. Except for the whole, you know, frontotemporal dementia part.

Mom fell last Saturday (one week and two days ago). She was eating breakfast at the kitchen table and Dad left for a few minutes to head out to the garage to give Tara-the-pointer her medicine. Dad came back, Mom was on the floor and there was lots of blood. She hit her head somehow on the way down, perhaps on the chair. Nice cut in her eyebrow. That turned into a black eye and a big egg on her forehead. It has healed fairly quickly, and now her eye area is a mass of yellow with some purple under her eye left.

So, I called the doctor early last week, a few days after the fall. I could not bring Mom in for an appointment because it’s too much for me now and Dad was away last week loading a store in NYC. I set up an appointment for today and Dad took Mom. The APRN took one look at the Mom’s noggin and says we should get an x-ray. So, after the appointment Dad took my mother across the parking lot to the building that does x-rays.

I should note here that Dad bought a wheelchair off of CraigsList a few weeks ago. A really nice Medline chair. It looks like this only it’s red:

 

Today was the first day that we needed to use it. Dad already had the chair folded up in the trunk of his car, in preparation for the appointment. He was just bringing it as a backup, just in case Mom was not walking well or she fell.

But turns out Dad was running late. He had me get Mom ready to go, and oh was she NOT pleased about having to get out of bed. He got home, we put her into the car. But when they got to the doctor’s office, he realized that he was already ten minutes late and it would take 20 minutes to actually walk with Mom into the office. So he whipped out the wheelchair and they zipped right in.

Turns out it was a blessing because with her balance, ain’t no way that Mom was going to walk across the parking lot to go get an x-ray.

 

The APRN also had Dad sign a DNR. Dad, who never admits to much that is emotional, said in email that it was very hard to do. This is the second time he’s signed one – once for my uncle.

I think making Dad sign a DNR after a head bump is a little damn extreme. But Mom is having seizures and, well, it just sucks all around.

Mom was completely unable to keep her head still for the x-ray. Well, duh. Then the tech told Dad that she really ought to be having a CT scan. Right. She can’t keep still for a few-second x-ray and she’s going to keep still for a CT scan? Come on. It would be a better view, though. But she would have to be sedated. Or, the CT scan tables have those head cradles that keep your head still.

Anyway. I don’t know how the x-ray thing worked out, but then they came home.

Mom now has a DNR bracelet that we’re not supposed to take off. I haven’t seen it yet, but Dad says looks like your average hospital bracelet. Great. Sure, it’s a wise thing to do. However: not only do we know she’s dying, now we’re going to be visually smacked with it every time we look at her.

 

Leader of the Band

I’ve taken to bringing my iPad and setting it up at the kitchen table during meals with Mom. I launch Pandora. I’ve been playing the Andreas Bocelli channel, but today I played the John Denver channel. She reacts just a little but not much.

Today Dan Fogelberg’s Leader of the Band came on and she stopped eating. Her face looked stricken. She loved Dan Fogelberg, I know. And I said “mom, Leader of the Band, remember?” and she nodded. Such a sad song. She remembered what it meant, too, I could see it.

And I started crying, couldn’t help it. Glad Dad was back in his office.

 

The leader of the band is tired
And his eyes are growing old
But his blood runs through
My instrument
And his song is in my soul –
My life has been a poor attempt
To imitate the man
I’m just a living legacy
To the leader of the band.

Where on earth did I put that diaper?

I changed mom’s diaper earlier and… I can’t remember where I put it. I remember tying it into a plastic bag. I remember hanging the bag on a doorknob temporarily – or that may have been my imagination. But it’s gone now. I have absolutely no recollection of taking it outside to the big garbage can. No way I’m going out in the dark and cold to look into the big garbage can to count diaper bags.

Oh Lordy. I just took another diaper bag outside. I really hope I threw out the earlier one. What on earth did I do with it? Surely I threw it out. What if the dogs found it and brought it to a special hiding place in the house? No way. No. I must have thrown it out.

Right?

Well, that is the last diaper change of the night. Mom is in bed and wide awake. Well, she did sleep all day so I’m not surprised.

Interviewing the new Caregiver

The interview with the new caregiver was this morning, luckily before the Nor’easter named Athena arrived. After the interview I headed directly home, right as the flakes were starting to fly.

This new caregiver seems really nice. Turns out, she was a speech pathologist in a former career. That is a lucky break, actually, because we really do need someone who will work on communicating with Mom: drawing her out, listening to her, prompting her to speak.

The caregiver clearly seems to love dogs, which is awesome. She got on the bed with Mom to come close to her to say goodbye, which was fascinating. She has clients that she works with, although I don’t know what she does, with a wide range of dementia types. She knows all about things like Lewy-Body Dementia and how it is different from Alzheimer’s, so she was open to learning about how FTD is yet another type.

Dad says he thinks that something is up with this one. Some story we don’t know, he said, but he is reserving judgement. Well, she seemed nice to me, so we’ll see. Of course everyone has a story. She seems like she’s in her early 50s and she grew up in this area so she speaks American English clearly and understandably – that will be much easier for Mom and Dad. I could understand Nina but it took some work.

And this woman, Sarah, lives close by, too. She also has tool/activities/things that can engage Mom as far as the speech pathology thing. That is a great sign, I think. I told her that Mom would be resistant to it at first, that Sarah would need to draw her out.

Mom is something of a recluse as it is – and so is my father. At least, they both are in their own home. They were never the types to go hang out with friends a lot or have people over. For years they have seen their best friends once a year – June and Bobby live in Baltimore – and that has been perfectly fine. My folks are very well suited to their stay-at-home life with each other. So anyway, having a strange person come in every day takes quite some getting used to.

I’ll be there when Sarah starts on Tuesday. Show her the ropes, that type thing.

Sarah did observe that Mom seems quite depressed. We took Mom off of the other antidepressant and she actually seems better. Maybe it would be good to add back a different antidepressant. Worth checking out.

So, we’ll see how it goes.

 

 

Alzheimer’s Advocates Explode Myths

From the New Haven Independent – Wendy DeLucca slowly began to notice subtle changes in her mother’s behavior and actions. It progressively worsened over the course of two years, leaving her incapable of comprehensible speech.

“It was very scary,” said DeLucca, the primary caregiver of her mother, who has Frontotemporal Dementia, commonly known as Pick’s Disease. Delucca began to notice “sharp changes in personality and behavior. She would interrupt rudely and didn’t catch on to social cues. She had never done this before.”

Through support groups and counseling sessions, DeLucca and her family were able to deal with the realization of her mother’s disease. “Having a loved one with dementia is like wearing a veil over your face everyday. The best way to cope with it is to reach out and get as much information as you can so you can be as caring and understanding as possible. They can’t help how they act,” said DeLucca.

DeLucca spoke as a part of the OneWorld Progressive Institute’s public-access television show called 21st Century Conversations, hosted by N’Zinga Shani. The show was recorded in the studio last week and will air on NHTV in November to coincide with National Alzheimer’s Awareness Month.

Joining the conversation were Dr. Rajesh Tampi, Maria Tomasetti, and Dianne Davis, who are “all intimately involved in the treatment, management, and interaction with patients, loved ones, and clients with the disease,” said Shani.

 

Continue reading the article here.

Election Day

Another thing to say goodbye to: Mom’s vote.

Here in the United States, our Presidential election is on Tuesday, November 6th, 2012. We’re choosing a President and Vice President. We also have a bunch of other choices, depending upon the state in which we live.

For years, Mom’s vote offset Dad’s – she voted Democrat, he voted Republican. This has been true since the first election I can remember being conscious of the different: Ford vs. Carter in ’76.

Our last Presidential election was four years ago. Mom was able to vote in that election. I’m actually not sure how she voted, but I remember that Dad took her very early, before work, about 6:30am.

This year, though, there’s no way she’s able to vote.