May 072015
 

The purpose of life is a life of purpose. ~Attributed to both Ludwig Wittgenstein and Robert Byrne

I was a nurse for thirty years. Near the end of my career, I began to notice that I was struggling to complete daily tasks. There was always an excuse; I was tired or had worked too many hours. I began having trouble with my knee and took time off work to have surgery. It was during this time that I started to take note of my problems.

I had days that I called “lights on” or “lights off.” When the lights were off I didn’t know when or what I ate, I had no idea if I slept or how long I had slept. Verbal and written information was hard for me to understand, and I got lost in familiar places. If I only lost my keys on any given day that was a good day.

cynthiaGWhen the lights were “on” I had to clean the mess I had made while the lights were “off.” Once, I went to wash clothes and there were no dirty clothes. I had been wearing dirty clothes for days, unaware of how long this had been going on.

In 2011, I found myself at a stop sign and I didn’t know where I was or how I got there. In that moment I decided to make an appointment to see my doctor. I had an eight-year relationship with my primary care physician and felt she knew me really well. During my office visit, I cried while talking with the nurse, and my physician agreed that the changes I was experiencing were not like me.

dinner

My doctor referred me to a neurologist and on my sixty-third birthday, with my son at my side, I underwent testing and was diagnosed with Alzheimer’s disease. My son asked questions, but I didn’t. I was happy to know there was a word for my problem, and although I know how this disease will end, every day I wake up and accept who I am that day.

pam

In May 2012, at the urging of my son and son-in-law, I moved into a residential community they both felt would be a good fit for me. I would be close to my family, my care team, and the specialists who conduct the clinical trial in which I am a participant. Yet, the most important part of my care team is my supportive children, and I was grateful to be closer to my son.

Shortly after moving, he spent Mother’s Day with me and afterward he wrote me a letter. I cherish this part:

Mom, I don’t want you to worry or be afraid. Let’s enjoy every single day and not think too much about whether you can remember as well as you could in the past. I will watch over you and won’t let anything bad happen to you. If the time comes when we need to do more for you, I will make sure you have everything you need to have a great quality of life. I wish I could change things. I wish I could take your illness for you and I can’t. All I can do is be there for you and love you.

Yes, I have a loving and supportive family. I am a very positive person and if something starts to bother me I ask myself, “Does this really matter?”


Chicken Soup for the Soul: Living with Alzheimer’s & Other Dementias is now available for purchase, with all royalties going to the Alzheimer’s Association. Read all the inspiring stories.

I accept my disease and am proud to be a National Early-Stage Advisor for the Alzheimer’s Association. I have made it my goal to inform the public that I live a great life with support from my family. I am very active, and I want to work to change the stigma associated with the word Alzheimer’s. I have met so many wonderful professionals who have allowed me to share my story in an effort to educate others who are dealing with the effects of this disease. With the support of the Alzheimer’s Association, I have advocated for the needs and rights of others with the disease.

I may be just one voice, but together with other advocates, we are unified.

To put an end to this fatal disease, we need to advocate for more research and clinical study participants. As a participant myself, I know I may not benefit from the studies, but someone else will—and thinking about that makes me smile.

As a legacy to my family, I want to be a part of a movement that educates others and helps advocate for people with Alzheimer’s and their families. As this disease progresses, I won’t remember anyone, but I want to live my life so that people will remember me.

 Author: Cynthia A. Guzman

 

From the book Chicken Soup for the Soul: Living With Alzheimer’s & Other Dementias by Amy Newmark and Angela Timashenka Geiger. Copyright 2014 by Chicken Soup for the Soul Publishing, LLC. Published by Chicken Soup for the Soul Publishing, LLC. Chicken Soup for the Soul is a registered trademark of Chicken Soup for the Soul Publishing, LLC. Reprinted by permission. All rights reserved.

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Mar 012011
 

Dear Readers,

As I discussed in an earlier blog post this month, the association between behavior and/or personality traits to developing dementia is a growing topic of interest that I am asked to discuss frequently. Depression, in particular, arouses a lot of interest, as many studies have shown an association between depression and poor physical, social and cognitive functioning. The latest study from the Women’s Health Initiative Memory Study (WHIMS) examined whether depressive symptoms in post menopausal women would increase the risk of developing mild cognitive impairment and/or dementia.

The Women’s Health Initiative (WHI) is a multisite population-based study that assessed the risk and benefits of hormone therapy in healthy postmenopausal women. The WHIMS, was designed to examine the effect of post menopausal hormone therapy on cognition and memory in healthy women aged 65 and older at the study baseline. A total of 7,497 community dwelling post-menopausal women were enrolled in WHIMS. They were aged 65y to 79y at enrollment and were free of Mild Cognitive Impairment (MCI) and dementia. Analyses for this study were based on the 6,376 ( 85%) WHIMS women who completed: (1) a six item Center for Epidemiologic Studies Depression Scale (CES-D), (2) a two item National Institute of Mental Health’s Diagnostic Interview Schedule (DIS) and (3) attended at least one follow up visit.

Typical questions asked on the CES-D were whether (1) the participant felt depressed (blue or down), (2) had restless sleep (3) enjoyed life (4) had crying spells (5) felt sad and (6) felt that people disliked the participant. The two questions from DIS asked whether in the past two weeks or more if the participant felt sad, blue or depressed and whether if they had for two or more years feelings of depression/sadness. Other baseline data included demographic information, medical history, lifestyle variables including physical activity and body mass index (BMI). Cognitive testing was measured using the Modified Mini Mental State Examination (3MS) at baseline and yearly after that.

The protocol for assessing MCI and dementia was divided into four phases that included administering to all participants a screening exam for cognition, a more in-depth cognitive battery, and then an assessment by a physician experienced in diagnosis dementia. If a participant was suspected of having dementia, they underwent the typical “work up” for dementia and that included a brain scan and laboratory blood tests. The physician then provided the final diagnosis of the type of dementia.

Of the 6,376 women included in these analyses, 508 met criteria for having depression. Women with depressive disorder were more likely to be African American, widowed, separated or divorced; had lower education, income, and global cognitive function. A total of 216 participants (3.4%) developed MCI , 102 (1.6%) developed dementia of any type and 285 (4.5%) women developed MCI or probable dementia during follow up. Those women who had depressive symptoms at baseline, were found at follow up (mean 5.4 years) to have a greater risk of developing subsequent MCI and incident dementia compared to those who were not depressed. These associations did not change after controlling for lifestyle variables, cardiovascular risk factors, cerebrovascular disease or antidepressant use.

Few population based studies have examined the association of depression to development of MCI and dementia in women. This study is the first to examine these associations in a large group of post menopausal women. Other notable strengths of this study include its large and multiethnic sample size, drawn from diverse communities across the US. These findings suggest that depression may indeed be a risk factor for dementia in women, and that adequate screening and possible intervention may prevent the onset of cognitive decline and dementia.

Here are 3 articles you can refer to for learning about this particular study or the latest research on depression, women and cognitive impairment:

Goveas JS, Espeland MA, Woods NF et al: Depressive Symptoms and Incidence of Mild Cognitive Impairment and Probably Dementia in Elderly Women: The Women’s Health Initiative Memory Study. J Am Geriatr So 59: 57-66, 2011

Dal Forno G, Palermo MT, Donohoue JE et al. Depressive Symptoms, Sex and Risk for Alzheimer’s Disease. Ann Neurol 2005; 57: 381-387

Yaffe K, Blackwell T, Gore R et al. Depressive Symptoms and Cognitive Decline in Non Demented Elderly Women: A Prospective Study. Arch Gen Psychiatry 1999; 56: 425-430

Thanks for reading.

Neelum T. Aggarwal, M.D.
Steering Committee Member, ADCS
This post originally appeared in Alzheimer’s Insights, an ADCS Blog.

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