Betahistine
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ALZHEIMER’S DISEASE: JUDGMENT AND PERSONALITY
Judgment
It is well recognized that a sufferer’s judgment becomes impaired quite early on. This is especially serious when the condition affects people who are still working and when they have to make difficult, complex decisions (doctors, drivers, judges, etc.)
Obviously the person may later be at risk from being ‘taken in’ by unscrupulous people and can be easily made to part with money and valuables, etc. Carers may need to take on the role of financial organizer if money problems develop. Home helps frequently cash pensions for their clients, buy the groceries and help pay the bills.
Personality
Personality and general behaviour also alter with this condition. For many they are their old selves albeit with memory and orientation problems. Some however have very up and down (labile) moods. An underlying feature of the personality before the disease may come to the fore, such as a tendency to anxiety or verbal spitefulness. In the later stages underlying characteristics may become very predominant and cause problems (verbal aggression, continuing anxiety requiring continuous reassurance). Often personal hygiene becomes a particular problem, especially for carers. Washing and bathing may become infrequent (often it is forgotten) and the person may then develop marked body odour. This can be made worse if clothing is stained with urine (many sufferers appear to leave the toilet before being quite finished, hence wetting their clothes). Less time and attention is taken with wiping their bottom, leading to soiled clothing and messy hands.
Carers are particularly anxious to avoid social embarrassment as occurs with inappropriate urination or having one’s bowels open in public. Undressing, accidental ‘flashing’ and the fondling of private parts are the other dreaded occurrences. In fact these acts do not occur often and can usually be prevented or minimized. A sense of proportion also has to be taken into account as it is not the act itself or the audience that should cause concern but the loss of dignity for the person concerned. It reminds me of a story (definitely true) that I heard recently. A rather posh woman was receiving skiing instruction as part of her expensive winter holiday. One afternoon high on the mountain with her instructor and about thirty other people she needed to pass urine quickly. She demurely approached her instructor who advised her to go behind a convenient boulder. This she did and gratefully lowered her ski pants and crouched down. Her instructor, ski party and everyone else on the mountain were thus shocked to see her bare bottom come into view and glide gracefully past them as she went backwards down the slope frantically trying to stop peeing and moving at the same time! The hot liquid had melted the snow and caused her to slide down the slope ‘mooning’ as she went.
As far as possible carers must try and keep their routines flexible. Some days will be better than others and it can be very difficult to keep a sense of proportion and priority. A sufferer should never be forced to try and do something but coaxed and gently persuaded. If there is refusal then if possible leave that particular task for a while and return to it later. The ideal is to tackle the problem together and not for the carer to take over. If only life were so easy!
*30/128/5*
