Expert: Mary Gordon - 3/7/2008

Question
Hi Mary...my name is Angela, I'm from Montreal, Canada. My question to you is regarding my 85 year old grandfather. he was diagnosed with Alzheimer's and dementia a few days ago...this has been a shock to all of us because there have no other cases of these illnesses in our family...the doctor has said that due to his bi-pass surgery a few years ago, an artery was blocked and the oxygen was not getting to his brain....at Christmas this year, he got pneumonia and was hospitalized, when he returned home he started to show sign of memory loss but no one clued in....when he was brought in for a regular doctors appointment last Thursday, they told us that he would not be returning home sadly...this has been very hard to understand...he no longer recognizes any one and it seems that he's regressed to when he was 20 years old...he thinks he's in his garage fixing cars...he lines up wheel chair and moves furniture as if he was repairing them...he has conversation with people from his past and has no clue that he had 10 kids and was married....my question is, how does this happen so quickly?...has his mind aloud him to find a happy time in his life and stayed there?...was it a trigger?...considering that no one else ever had any of these illnesses? or was it only due to the bi-pass surgery?...his physical health is outstanding considering he's 85, how long does someone usually live with this? and can it be reversed through therapy?...as a spiritual person, i believe everything happens for a reason, and i know that god doesnt give us anything we cant handle...and I've made my own peace with this....is it wrong that i feel like just sitting and listening and taking notes to experience what it is he's seeing and feeling...i feel like we now have an open window to the past...

i thank you in advance for taking the time to read this and hope that my concerns made a bit of sense:)

sincerely, angie.

Answer
Hi Angela,

You should realize that "dementia" is just a term like "fever". It describes a set of symptoms - which in the case of dementia is cognitive impairment. It is NOT a diagnosis - in other words, it doesn't tell you what CAUSED the dementia, what injury or disease process. From what the doctor has said, it doesn't sound like dementia from Alzheimer's. It sounds like a brain injury from vascular blockage, and consequent oxygen deprivation. This is usually called vascular dementia or "multi-infarct" dementia.

Alzheimer's itself is a specific disease, and it generally progresses more slowly than what you are describing. This is not to say he might not ALSO have Alzheimer's damaging his brain, but it sounds much more likely that he has multi-infarct - in other words, he has little blockages contributing to cumulative brain damage from lack of oxygen. He also might not have been getting enough oxygen from the pneumonia itself.

Keep in mind that the brain is a very delicate organ - and as we age, we all become more and more at risk for things that will damage our brains. By the time a person - and this is ANYONE, reaches the age of 85, their odds of having some health issues that have affected their brains are almost 50-50. It can be from vascular blockages, Parkinson's disease, dietary problems, low oxygen, thyroid problems, Alzheimer's, and a long laundry list of other thing. So even with no family history of a specific cause of dementia, that doesn't mean a person is safe from other diseases that can damage their brains.

It is very unlikely he will recover in any meaningful way. If he has multi-infarct, it usually progresses - the person has an endless series of very tiny blockages occurring all the time, so tiny that each event doesn't cause symptoms, but over time, the damage accumulates.  What you are seeing is the result of irreversible damage to his brain.

Having any form of dementia does mean a shortened lifespan - but at 85, he already has a limited number of years ahead. Why any form of dementia shortens life is that quality of life becomes so important to the family. They want the person to be as comfortable, happy and peaceful as possible. It becomes very difficult to detect health issues in a person who can't tell you how they feel, describe symptoms, remember when something started etc. They don't understand the purpose of what may be uncomfortable or painful tests, medical procedures, therapies and treatments, and may be frightened by them. They can't cooperate. Many times families decide there is no point to put their loved one through all that poking and prodding if there is nothing to be gained in terms of quality of life. They decide to keep the person out of pain and serene, but let nature take its course.

So its hard to say how long he will survive. If the brain damage continues to progress, he will eventually have more and more motor problems - he will lose his ability to walk, feed himself, will become incontinent etc. As you can image, at that point, the person becomes very susceptible to all kinds of health issues that can threaten their lives.

I'm sorry to paint so bleak a picture. You are doing exactly what you should be doing. You are loving him, and bringing him happiness with your visits, and by listening to him. No one can appreciate and love him like you can.  If you have old photographs in the family, it might be worth bringing them to a visit and getting him to identify people if he can (he may not be able to - one thing that has happened to him is agnosia, an inability to recognize people, places and things, because the part of the brain that does that has some damage).  If he can recognize anything from old pictures, it might spark some great memories he would enjoy talking about, and be a great way to pass the time with him.

My mother in law had Alzheimer's, and although she forgot  she was married, just like your grandfather, she LOVED old photo albums, and even when she had lost her ability to speak coherently, looking at pictures was something she enjoyed. Every now and then she would surprise us by coming out with a complete coherent sentence about something in a a picture, or by pointing out someone she had previous not appeared to remember.

I know this is very hard to deal with emotionally. All you can do now is treasure him for the wonderful man he has been, and the legacy of a full life well spent he has given all of you.  Hope this helps.

Thinking of you.

Mary Gordon
Toronto