Caring for a loved one with Alzheimer’s is challenging. Here are answers to two questions, asked by Alzheimer’s caregivers to the editors of our Johns Hopkins Memory Bulletin. The subjects: Confusion about place … and symptoms of aphasia.
Q. What do you recommend that I do for my grandfather, who doesn't realize that he is actually home? Gramps worked for the railroad for 48 years and did a lot of traveling during his career. Now that he is 90 and was diagnosed with Alzheimer’s a year ago, he suddenly says that someone should pick him up, along with his luggage, and help him get home. This has been going on for a month, and I don't know how I can convince him and ease his concerns that he is already safe at home. Westport, CT
A. You are describing what doctors refer to as an agnosia, an inability to recognize a familiar object, person, or place despite intact eye function. This symptom can be seen in other brain diseases that affect the parietal lobes of the brain, so it is not only a symptom of Alzheimer's disease but does become common in Alzheimer’s as the illness progresses. This is not merely "forgetting" where one lives; many individuals with this problem can accurately describe the home they live it. Rather, it is an inability of the brain to merge the memory of a place with the perception the person is seeing at that time.
Advice: In my experience, there is no benefit and sometimes harm in repeatedly trying to convince the patient that "this is your house." I think it would be best to distract him by changing the subject, reminiscing about his home, or empathizing with his distress.
Q. My wife was originally diagnosed with early Alzheimer's disease but now the diagnosis has been switched to primary progressive aphasia. I would appreciate your views on diagnosis, prognosis, and treatment possibilities. Via e-mail
A. Primary progressive aphasia, or "PPA," is a condition in which a person has a slowly progressive loss of the ability to communicate through speech. Most individuals who have this condition are found to have fronto-temporal dementia at autopsy but some individuals have the pathology of Alzheimer's disease located only or primarily in the brain's language center.
Advice: Individuals with PPA have marked difficulty finding words and may eventually become unable to generate language through speech. They can often comprehend more than they can express, so if a person gives them 'yes' or 'no' choices for responses, , communication is easier.
Many but not all individuals with PPA are frustrated by their difficulty with language expression; when this is the case, it is often helpful to them to let them know you recognize their frustration.
