INDIA: Alzheimer's Steals More Than Memory

MUMBAI (The Times Of India), November 11, 2004:

It happened without warning, early one day last summer as they prepared to go out. Gloria Rapport's husband raised his arm to her, fist poised. "He was very close to striking me," she said. What had provoked him? "Nothing," she said. "I asked him to get into the car."

Rapport's husband, Richard, 71, has Alzheimer's disease. His forgetfulness and confusion began about nine years ago, not long after they married. But emotional troubles have begun of late.

Anxiety came first: he suddenly feared being left alone in the house.

Outbursts of anger followed.

The man she had always known to be kind and gentle could in an instant turn "cunning, nasty, aggressive, menacing."

"The behavioural changes I've seen ae absolutely frightening," she said.

Although memory loss is the best known Alzheimer's symptom, the disease can also cause psychiatric problems that lead to profound changes in personality, mood and behaviour.

People who were happy and good-natured for most of their lives suddenly become fearful, depressed, deluded or angry, sometimes even violent.

Many families hide such symptoms, and perhaps as a result, psychiatric problems were long thoughtto affect only a minority of people with Alzheimer's disease or other types of dementia.

Only recently has it become clear that emotional and behavioral troubles are nearly universal among people with Alzheimer's disease and the problems are frequently intracable and more upsetting to families than the mental slowing.

Depression and apathy are the most common psychiatric symptoms. But agitation, aggression and psychotic behaviors are the leading reasons Alzheimer's patients are put into nursing homes.

"They are extraordinarily distressing and wearing on care givers," said Constantine Lyketsos, a psychiatrist and Alzheimer's expert at John Hopkins.

More than four million Americans have Alzheimer's disease, and the number is expected to increase as the population ages.

Dr.Lyketsos said doctors had become increasingly aware that elderly people who suddenly showed signs of mental illness might actually have Alzheimer's disease, though in the past they might have been given diagnosis like "late-life psychosis", depression or nervous breakdown.

Rapport said, "Most families won't talk about it. I equate this disease with how leprosy used to be. We've lost good friends, and we have family members who won't have anything to do with us. I think they're afraid of it, and there's a real stigma that the person is crazy. I think it's why a lot of families hide people away who have it."

The symptoms distress not just families, but the patients too. "If your moods are labile or you get anxious and scared, there's a fair bit of suffering that goes with that," Dr. Lyketsos said.

"If you have visions, or develop ideas that people are trying to steal from you or hurt you, there's a fair bit of suffering."

By Denise Grady The New York Times News Service