A Layman's Comparison of

Alzheimer's and Dementia

People who suffer from dementia often seem to exhibit symptoms that could easily be mistaken for Alzheimer's. And the early stages of Alzheimer's can easily appear to be increasing forgetfulness -- or what is often called a "senior moment". The following story is a comparison of the two conditions that were observed by a couple who were the son and daughter, respectively of Janet and Susan - and neither of whom are medical professionals.

Janet died in 2002 in a nursing home in Overland Park, Kansas under the care of the Catholic Charities Hospice. She was 91 and had been in a succession of retirement homes, assisted living facilities and nursing homes for about eight years.

Susan died in early 2003 in a different nursing home in Overland Park, Kansas. She was 83 and had experienced the progression of Alzheimer's for about six years.

Janet was mentally alert until about a year before she died. However, her memory had become erratic for about four years before her death. Six months before she died, she asked us, "Why does this have to take so long?". She knew she was dying and had accepted that fate. She also had a strong conviction that she would be able to rejoin her deceased husband in the hereafter. She didn't die of any specific dreaded illness such as Alzheimer's. She had experienced a series of mild strokes but they didn't incapacitate her. But, unlike Susan, Janet suffered from an assortment of ailments including an irregular heart beat (arithymia), a failing kidney, injuries from a variety of falls, near blindness and near deafness. For the last three years of her life, she was unable to read, to work with the varied crafts that she enjoyed or to play the piano -- which she had been able to do since she was five years old. Her greatest frustration in her final years was the enormous boredom from not being able to hear or to read.

Susan enjoyed exceptional good health in every way except for the terrible disease of Alzheimer's, which affected her gradually. At first, her close friends in a bridge club began to notice her failing ability to play the game -- which she had played well for many decades. Then, her daughter began to notice that her memory was failing when she would lose her car in parking lots and would forget more and more events and people who had been close to her. She began to have accidents that were unusual for her because she always had exceptional balance. (She had taught dancing when she was younger.) She had been living independently until about four years before her death and she strongly resisted having to move to an assisted living facility. However, shortly after she arrived in the assisted living facility, a gentlemen who lived there began to spend a lot time with her. So she soon forgot about being angry at having to move from her apartment.

For about two and half years, Susan's daughter spent most  of her Sundays visiting with Susan and her boy friend and would take both of them out to lunch or other activities. The family of Susan's boy friend would include Susan in their family activities so she enjoyed twice the attention she would have otherwise received. After about two and a half years, her condition had deteriorated to the point where it was necessary to move her to a smaller and restricted section of the assisted living facility so that she would get more personal help with eating, bathing and other activities of daily living. During this time she was cheerful and seemed not to be fully aware of her deteriorating mental capability. Until the end, she could recognize her daughter and those who cared for her on a daily basis. About six months before she died, it was necessary to move her to a nursing home. The day nurse in her section had done extensive work with Hospice and it did not seem necessary to secure their help. The nurse and doctor in Susan's nursing home did not attempt to intervene in a process that everyone knew was not reversible. Instead, they provided as much medical comfort as possible. In the end, the Alzheimer's disease appeared to shut down her ability to drink and she died from a lack of fluids.

Both Janet and Susan had explicitly and clearly indicated that they did not want to be subjected to extra-ordinary efforts to prolong their life if such efforts would result in permanent incapacity. In Janet's case, her doctor and the nurses would not administer a program to merely minimize her pain so her son brought in Hospice to become her surrogate medical provider. In essence, he delegated his legal powers (relative to medical care) to Hospice, but continued to be involved in her care decisions. As soon as Hospice was involved, the doctor and nurses become fully cooperative. It seems that Hospice provides a legal protection for the doctor and nurses and the facility from mal-practice claims.

With Susan, the nursing home doctor and the nurses did not resist her requests which were supported by a living will that had been executed many years before. Perhaps it was because the outcome was so much more certain or perhaps it was because the nurse in charge had direct experience in working for Hospice.

After the funerals -- which occurred within a few months of each other -- their children began to wonder if Alzheimer's is harder on the victim or on the family caregivers. As far as they could tell, Susan had no awareness of her disease and was not really aware of her deteriorating physical condition. They were at her beside during the last days of her life and she did not appear to experience any pain. But it took a toll on the children to watch the deterioration and to see her slip away.

With Janet, she was aware of her condition and needed an increasing dosage of medication to relieve the pain. While she was stoic about her final days, she was much more aware of her imminent death then Susan appeared to be.

These observations may be medically atypical and are not intended to suggest that everyone with dementia or Alzheimer's will have the same symptoms.