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Alzheimer’s
The Stranger in the Mirror 

by Brenda Fountain, BSN, RN

As a nurse, I have always found it difficult and frustrating to understand the needs of a person with Alzheimer’s disease. Alzheimer’s is the most common type of dementia. It is a progressive degenerative brain disease first discovered in 1906 by Dr. Alois Alzheimer, a German physician. His autopsy of a patient’s brain indicated abnormal amyloid plaques and neurofibrillary tangles on the brain. His patient was a woman in her late 50’s who had regressed in her memory and abilities to childhood. The plaques and tangles are now the indications of Alzheimer’s disease, though study is ongoing regarding the cause of the plaques and tangles. As a nurse, using the medical model of disease and progression should be sufficient to begin to care for people with Alzheimer’s disease.


But it was as a daughter that I really began to understand Alzheimer’s. My mother became a stranger to herself. She didn’t recognize pictures of herself nor her reflection. It doesn’t seem possible, but I watched my mother slowly regress into infancy. I could do nothing to prevent it, so I threw myself into studying everything possible, hoping to understand, hoping to somehow ease my sorrow. The knowledge that I gained did nothing to ease that sorrow but it did help me in caring for and understanding my mother.


In this article, I hope to provide information on caring for a person with this disease through personal experiences and education. According to the Alzheimer’s Association, a 1993 national survey indicated that Alzheimer’s disease could be found in one in ten persons over 65, five of ten persons over 85 and that four million Americans had AD, 19 million Americans had a family member with AD, and 37 million Americans knew someone with Alzheimer’s disease. With the aging of our baby boomers, those numbers are going to escalate at a rate that will be draining the emotions and finances of the people of this country. Becoming more aware of Alzheimer’s and its treatment is a necessity not only for the medical world, but also for every person.


The article “A Trip Back in Time” by Christopher Johnson, PhD is an excellent guide to understanding the process of regression. Dr. Johnson is a professor at the Institute of Gerontology at the University of Louisiana at Monroe. His article provided the first step for me in defining the disease process. It helped me to understand the decline and the moments of clarity that sometimes occur. At age 74, my mother still knew who I was but when asked her age, she responded that she was 43 years old. She did not recognize her grandchildren. How could she, they were only infants or had not been born. But yet, further along in her regression, she suddenly asked if my son was out of the military yet. Dr. Johnson uses spiraling loops to indicate how there can be fluctuations in regression with AD. His model would be very helpful professionally and personally for any Alzheimer’s caregiver.


As with most diseases, there are stages to Alzheimer’s. Reisberg’s Seven Stages of Alzheimer’s Disease (also known as FAST-Functional Assessment Staging) is a very helpful tool that breaks down each stage into specific activities of daily living (ADLs). ADLs can still be accomplished by a person with Alzheimer’s disease dependent on their stage and dependent on our understanding of their stage. Understanding the person’s stage of illness is important to every aspect of their care. Early Stages 1-4 still allows decision-making. The person should be included in decisions that will eventually affect the end of their life. Excluding them isolates them and certainly contributes to early feelings of paranoia. It should be noted that Stage 1 is asymtomatic, which means everyone could have stage 1 Alzheimer’s disease.


While our mother was still cognizant of her reality (Stage 4), my sister and I talked with her about her choices. The move was easier for her and us because we were following her instructions. My mother lived alone until she was unable to perform daily activities (Stage 6c). My sister and I checked on her often and hired someone to help. We did eventually place her in the nursing home of her choice. What we did not fully understand at the time was that the placement should have been more thoroughly researched with her future needs in mind, as well as her present needs. My mother’s choice was a nursing home that was familiar to her and was located close to my sister. The home was pleasant and secure with a kind staff. My sister could see her everyday. I came on the weekends and called my mother every night as long as she could recognize the concept of the telephone. The problem occurred as my mother’s disease progressed. She began to wander into other residents’ rooms thinking that it was her room. She forcefully insisted that the person leave her room by grasping the lady’s already broken arm. Because the staff had not been trained for a true Alzheimer’s unit, they did not know how to handle this problem, nor did they have a dedicated Alzheimer’s unit. She was promptly admitted to a geriatric psychiatric facility.

                                                                   Cont'd Part 2

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