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Alzheimer`s Disease/Alzheimer, dementia, aortic stenosis


Dear Mary, good day to you.

My mom is going on 85. Aortic valve constriction was first diagnosed in about 2002. She now has aortic stenosis to such a degree that operation is urgent. But, she does not want it. Nor the catheter method.

Along with this in about 2005 I began noticing real short term memory loss. After CT examination, a year two back, it is revealed that she has shrinkage of the brain quite markedly. She also has cataract on the retina in the left eye which is causing blindness there now. The head eye specialist at our clinic did not want to operate on her about 3 years back. She also has osteoporosis in her spine. In her neck too.

She has complained more recently of pressure on her head. Having measured her blood pressure it was 126 systolic (she is taking Duopril for high blood pressure. All I remember is that the diastolic was in the upper 60's region.....But she also said that this pressure on top of the head comes and goes.....she cannot remember what happened even a few minutes ago sometimes so this answer I think was at the time that I asked, there was no pressure.

Now the family doctor after some hesitation found a word mom is exhibiting sometimes confusion, misplaces things (not all things), refuses to bath or for me to wash her hair, won't take instructions for her health whereas before she knew these things. She can't take any change of furniture  or replacements...she used to do cross word puzzles mostly all day long but as of about 4 months now all she does is lie on the sofa looking at the trees and birds outside through the window. She used to wash her own underwear and socks. Recently I noticed that this is not happening anymore....etc. All in all her personality has changed. Anger fits used to come...but less these days. But they are there when I try to change her oncoming habits that are not good for her.

She also has experienced weakness and a pain from her left armpit down her left side.....but we had gone through a series of doctor visits before because she was complaining of pains in her belly. But after many tests all were negative, so, I don't quite know if I can believe her complaints sometimes.

I would like to ask: What is the difference between dementia and alzheimer's? Also because of the fact that we did not do the heart valve replacement when it was first noticed that the valve is stenosing, is this the reason that she has developed alzheimer's or dementia? I am thinking because of the progressively restricted blood flow to the brain.

Hi Maria, your poor mother! This must be very hard on both of you.

The word "dementia" is not a diagnosis. It is a word that describes a cluster of symptoms - which can include a  loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal ageing. Usually when someone says dementia, they mean the person has deficits in orientation, problem solving, memory, language and attention. In other words, a person who is confused in many aspects of their life.  Dementia is always caused by some underlying disease process, nutritional or hormonal deficit, an injury or other physical issue.

Saying someone has dementia is like saying someone has a fever - it describes a symptom you can detect, but it doesn't tell you what is causing the problem. What is causing the problem is the diagnosis, and it is important because if you know the cause, you have some hope of knowing what you can do about it, if anything.

What you are describing sounds a lot like she is in mid to later stage Alzheimer's, but there are many, many distinct causes of dementia in the elderly. Brain shrinkage seen on MRI imaging is strongly suggestive of Alzheimer's and may actually start to occur many years before the person has noticeable symptoms.

Another major cause is "multi-infarct" dementia, sometimes called vascular dementia, which is caused by an endless series of tiny strokes or obstructions to blood flow in the brain. Each tiny obstruction does a little damage, often too small to produce symptoms, which accumulates over time. It is also not uncommon for the elderly to have more than one health concern going on at once that is impacting their brain - so she may have multi-infarct and also have Alzheimer's.

I don't think the stenosis is causing what you are seeing. Although this can be fixed surgically, an operation may not be an option for those who are as elderly as your mother. People with advancing dementia due to Alzheimer's do not do well at all with surgery involving anesthesia. It often makes them markedly worse, and they tend never to recover the ground they have lost mentally.  So, she is very unlikely to benefit from the surgery now. Her lifespan is likely  limited - I don't know if the doctor explained to you, but progressive dementias like Alzheimer's are fatal diseases on their own.  You may want to ask for a referral to a neurologist with a specialty in dementias in the elderly, who may be able to give you a diagnosis and some advice on what the future brings, and if there are any medications that might slow things down or make her more comfortable.  

The best focus is generally to try and keep her as content, happy, and safe as possible. Quality of life is the aim, rather than quantity.

Below I have pasted the most generally used set of stage descriptions for progressive dementia, to give you a feel for how she is likely to change as whatever is causing her brain damage progresses.

I know this is very challenging and I am thinking of you.

Adapted from Reisberg, B., Ferris, S.H., Leon, J.J. & Crook, T. The global deterioration scale for the assessment of primary degenerative dementia. American Journal of Psychiatry, 1982

Level 1

No cognitive decline - (or Normal Adult). No subjective complaints of memory deficit. No memory deficit evident on clinical interviews.

Level 2
Very mild cognitive decline (forgetfulness or normal older adult). Subjective complaints of memory deficit, most frequently in the following area:
(a) forgetting where one has placed familiar objects;
(b) forgetting names on formerly knew well. No objective evidence of memory deficit on clinical interview.
No objective deficits in employment or social situations. Appropriate concern regarding symptoms.

Level 3
Mild cognitive decline (early confusional or Early AD). Earliest clear-cut deficits. Manifestations in more than one of the following areas:
(a) patient may have gotten lost when traveling to an unfamiliar location;
(b) co-workers become aware of patient's relatively low performance;
(c) word and name finding deficit becomes evident to intimates;
(d) patient may read a passage of a book and retain relatively little material;
(e) patient may demonstrate decreased facility in remembering names upon introduction to new people;
(f) patient may have lost or misplaced an object of value;
(g) concentration deficit may be evident on clinical testing.
Objective evidence of memory deficit obtained only with an intensive interview. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms.Deficits noticed in demanding employment situations.

Level 4
Moderate cognitive decline (Late Confusional or Mild AD). Clear-cut deficit on careful clinical interview. Deficit manifest in following areas:
(a) decreased knowledge of current and recent events;
(b) may exhibit some deficit in memory of one's personal history;
(c) concentration deficit elicited on serial subtractions;
(d) decreased ability to travel, handle finances, etc.

Frequently no deficit in the following areas:
(a) orientation to time and person;
(b) recognition of familiar persons and faces;
(c) ability to travel to familiar locations.
Inability to perform complex tasks. Denial is dominant defense mechanism. Flattening of affect and withdrawal from challenging situations occur.

Level 5
Moderately severe cognitive decline (Early Dementia or moderate AD). Patient can no longer survive without some assistance. Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated. Frequently some disorientation to time (date, day of week, season, etc.) or to place. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s. Persons at this stage retain knowledge of many major facts regarding themselves and others. They invariably know
their own names and generally know their spouse's and children's names. They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear.

Level 6
Severe cognitive decline (Middle Dementia or Moderately Severe AD). May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and sometimes forward. Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will display ability to orient in familiar locations. Diurnal rhythm frequently disturbed. Almost always recall their own name. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include
(a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror;
(b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities;
(c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur;
(d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of

6a - Requires Assistance dressing
6b - Requires Assistance bathing properly
6c - Requires Assistance with mechanics of toileting
6d - Urinary incontinence
6e - Fecal incontinence

Level 7
Very severe cognitive decline (Late Dementia or Severe AD). All verbal abilities are lost. Frequently there is no speech at all - only grunting. Incontinent of urine, requires assistance toileting and feeding. Lose basic psychomotor skills, e.g., ability to walk, sitting and head control.
The brain appears to no longer be able to tell the body what to do. Generalized and cortical neurologic signs and symptoms are frequently

7a - Speech ability limited to about a half-dozen intelligible words
7b - Intelligible vocabulary limited to a single word
7c - Ambulatory ability lost
7d - Ability to sit up lost
7e - Ability to smile lost
7f - Ability to hold up head lost  

Alzheimer`s Disease

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Mary Gordon


Several years direct experience as caregiver for family member who died of end stage AD. Did lots of research and dealt with a lot of health care professionals and caregivers over the 7 years from diagnosis to the end. Used various care options from community based resources to increasing levels of institutional. Mother of three, two born during our loved one's decline, so I know what it is to be the ham in the sandwich, taking care of the older generation and the younger at the same time and trying to balance everyone`s needs. Ask me, I`ve probably been there, done that. We made lost of mistakes and learned everything the hard way - but you don`t have to! If I can`t answer your question, I`ll steer you to a place or person who can.


Currently a program manager for a large utility company. My Alzheimers experience comes from having the illness in our family. Out of necessity, we did a lot of research in order to understand the disease, plan for what might come next, and make the right decisions to help and support our loved one. Please note, I am a Canadian living in Toronto, and therefore am not the best person to ask about US regulations and insurance rules!

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