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Alex Stevens

Dr. Andrus

6 November 2014

English 1001.110

Losing Your Story

“Alex, I wish you were a kid back when your cousins Kim and Eddie were little,” stated

my grandma as she was walking into the living room with another puzzle for us to put together.

I was confused as to why it mattered that my cousins were young so long ago, so I asked my

grandma why. Grandma sat down on the couch next to the table where I was making my puzzle

and began to tell me a story.

Stories can be told, written, or shown through pictures but one thing that no one expects

is for the original story to be changed drastically. When someone writes that they went to a park

at 7 in the morning, that is the story, it should not change to a different time or place. Stories are

pieces of history in each and every person’s life. A true story is not a form of gossip that gets

spread around and changed by each person, but rather a non-changing memory of a certain event.

Unfortunately, at a young age I learned that stories can become changed without warning.

“When your mom or dad brings you over to my house do you ever see the street sign for

the road Paxton?” my grandma asked. I shook my head no and she kept going with her story.

“When Eddie and Kim were young there weren’t many houses on that street, just a huge

hill and very few cars. One day grandpa needed to go to the store, but I think he was just a little

overwhelmed with Kim and Eddie’s loudness that he decided to walk to the store and waste

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some time. Your grandpa left his car keys sitting on that tan table right over there, so I decided

to take his keys and take your cousins out for a ride.”

“But grandma do you even have a license?” I interjected.

“No, I never have, but I had learned how to drive, Alex that’s not the point” she argued.

“Back to what I was saying, we all got in the

car and I started driving down the street. It

was so much fun and definitely the easiest way

to get your cousins to stop fighting. We drove

over to Paxton and went all the way to the top

of the hill. After turning the car around I decided to coast down the hill and we made it a game

to see how fast I could go before the part where the street reached a plateau just before the stop

light. Kim and Eddie were screaming as if they were on a roller coaster and it was the most fun

the three of us had had in a long time. Too bad if I were to take you and your brother to do that it

wouldn’t be safe anymore because of how busy Paxton is, it’s a real shame.”

On June 14, 1864 Alois Alzheimer was born in Marktbreit, Germany. The Hospital for

Mentally Ill and Epileptics was where Alois began his medical residency. Alzheimer became

increasingly interested in neuropathology and nervous system disorders. As well as studying

neurologically dementing disorders Alzheimer also studied the psychology of forensics, birth

control, and forms of epilepsy. Alois Alzheimer longed to investigate many aspects of the

human brain.

In 1901 a fifty-one year old woman, Auguste D., was admitted to the hospital under

Alzheimer’s care. The woman’s symptoms ranged from a jealousy towards her husband to a

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delusion where she felt someone was trying to kill her. Alois began to ask Auguste D. questions

and document her answers by hand. Alois Alzheimer’s questions are simple and easy for most

people to answer such as “What is your name?” to which she replies “Auguste” then he proceeds

to ask her last name and she again says “Auguste.”

Auguste may have been confused and unsure of answers to Alzheimer’s questions, but

she showed signs of good health. Auguste’s pupils could constrict appropriately to light. Her

speech was clear, even though her thoughts were not. Her reflexes were normal and no signs of

cardiac problems were found. Auguste’s memory and delusions became worse and worse as

time went on, by the time four years had passed with her being in the hospital she died.

Alzheimer said that the disease Auguste D. faced was “A characteristic serious disease of the

cerebral cortex” (Maurer). After the discovery of Auguste D.’s condition the eponym Alzheimer

was named for Alois Alzheimer’s discovery.

“Grandma, will you help me with this puzzle?” I asked after about a half hour of no

success with the puzzle. She came over to the table where I had already constructed half of the

puzzle and within ten seconds grabbed a piece and placed it in the correct spot. At six years old,

I thought my grandma was a genius because it seemed that no matter how hard the puzzle was

for me, she could always complete it almost instantaneously. I hoped that one day I would be

able to solve puzzles as fast as my grandma could.

The puzzles were a test of my knowledge growing up. I struggled with them and often

needed assistance, but by the time my parents came to get me at the end of the day I always had

them completed. Within the next few years grandma started to forget simple things such as why

she had just gotten up to leave the room or where she left her comb that she always had in her

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pants pocket. It was strange to me that the person who had taught me so much was starting to

forget things that I believed she had always known. My parents told me that grandma was

getting older and that sometimes older people’s brains cannot hold as many memories as they

used to.

Various tests can be done to diagnose a patient with Alzheimer’s. Paul Donohue, of the

North American Syndicate, wrote about the finding that there is not a blood test or bacterial test

that can be done to diagnose Alzheimer’s, rather there are cognitive tests. I found that my

grandma was being tested much like I had been with my puzzles. She would be told three words,

and then asked to repeat these three words three minutes later. It shocked me how much

difficulty grandma would have repeating these words, sometimes she could not even remember

one word. My parents told me to keep asking grandma questions like I always had because it

would help her remember.

Without degenerative neurological conditions it is not uncommon to notice that everyone

undergoes certain signs of aging. Harada, Natelson Love, and Triebel have conducted research

on cognitive aging throughout the lifetime of humans. These three individuals have found that

people who are as young as thirty years old start to lose their processing speed. Processing speed

deals with the ability to react to cognitive or motor stimuli. Declarative memory is memory that

has explicitly happened to the person whereas nondeclarative memory is memory that has

happened outside of a person’s memory; it remains constant throughout a person’s entire life.

The decline in memory has been linked to a decline in the amount of gray matter that is within

the human brain. Both types of memory, declarative and nondeclarative, can decline in older

adults due to the slowing of processing speed (739-752).

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A study was conducted in fifteen Canadian families that had a member who was affected

with Alzheimer’s. Each of the families felt that their affected family member received a loss of

independence throughout the worsening of their condition. The affected family members

became dependent on the care of their family, due to the constant state of confusion that

Alzheimer’s brought upon them. A family member recalls an account in which their loved one

wandered outside to use the bathroom and had to be located then brought inside and the next

morning the man asked “’Who are you?’” (Wuest 439). The lack of understanding of the patient

of who their family members are leads to a distancing in families where they allow the affected

individual to think of them as strangers.

“Hey, Kim do you remember when we drove down Paxton last week? Do you want to go

again?” My grandma asked me minutes after I got to her house. I remembered her telling me the

story of driving down the hill with my cousins when I was about six years old.

“Grandma this is Alex, Kim’s not

here,” I explained.

“Kim, stop being silly do you not

remember when we went last week?

You and Eddie had so much fun,” she

stated with such confidence.

I looked over at my grandpa after

grandma had finished talking and he seemed broken down and hopeless. I asked him what was

wrong and he just told me grandma was more confused than usual that day and to let her call me

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Kim. Kim and I do look a lot alike, beside the fact that I am much younger, so I decided that this

probably was not that big of a deal.

Alzheimer’s is a terminal condition in which no one has found a cure for. Shan Yaso, a

medical writer and health consultant, has found that certain risk factors lead to developing

Alzheimer’s. These risk factors include smoking, alcohol consumption, being overweight,

having diabetes mellitus, and having hypertension. My grandma had none of these risk factors

when she was diagnosed. Now certain drugs can be taken to delay the rapidness of the disease,

but when she had it little was known about treatment options. People who are diagnosed with

Alzheimer’s can take donepezil, rivastigmine and galantamine to improve symptoms, but these

drugs will not get rid of the disease. Once diagnosed with Alzheimer’s it is an inevitable

condition that will be a part of the affected person’s life indefinitely.

As each day passed my grandpa seemed to become tired, agitated, and stressed. It was

apparent that my grandma’s condition was affecting him too. He helped her each time she forgot

where she was going and was constantly making sure she did not leave without him. She would

forget that she left the stove top on, and my grandpa would check the kitchen every hour. Even

though he was stressed out by her progressing Alzheimer’s it was apparent that he was thankful

she still knew who he was.

Many families have taken on the hardship of caring for someone with Alzheimer’s. In

Northeast Portland Laurel Roberts decided to take in her mother after finding issues in the ways

her mother was treated in a retirement community. Laurel Roberts found that there were certain

precautions she could make to better care for her mother, such as putting a deadbolt on the door

to ensure her mother stayed home at night and did not wander off. Laurel learned valuable

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organization skills to help her take care of her mother. Throughout the time where she cared for

her mother Laurel learned that, “’You have to delegate. You can’t do it all alone’” (Patel). By

delegating care among multiple family members it releases the likelihood of the primary

caregiver developing depression.

Everyone started to visit my grandma more often at the beginning stages of her

Alzheimer’s. Kim would stop by and tell my grandma about how she was a nurse now, telling

her stories about the children she takes care of. Aunt Linda would come by with grandma’s

favorite soup and eat lunch with her. Grandma’s sister Peggy would randomly buy groceries and

bring them over to my grandma then stay long enough for them to start talking about their

younger days of going down water slides at Coney Island. My dad started spending more time

with his parents, since he was usually only there long enough to drop me off occasionally to

spend the day with my grandparents.

In February of 2008, seven years after my grandma’s initial symptoms of Alzheimer’s

occurred, my grandpa’s health started taking a turn for the worst. He had been with my grandma

every day since her condition started. His skin started to turn a greenish tint and he was taken by

ambulance to the hospital. My grandpa always seemed to be the stronger individual between the

two of my grandparents so I believed he would be released from the hospital and good as new in

no time.

MacIntyre, a writer of Thomistic Aristotelian perspective of virtues, believed that those

who work to help others are known as Independent Practical Reasoners. MacIntyre wrote “No

one can become an IPR without the development of certain virtues, and these virtues cannot be

appropriately acquired without help and instruction from other people who have also developed

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the virtues” (Butts 401). Independent Practical Reasoners become vulnerable to the dangers of

their own world because they are more deeply concerned with caring for someone else. In many

cases when a person is caring for a person of an altered mental status they begin to lose sight of

caring for themselves.

In March of 2008 almost all Elementary schools got dismissed early. Snow had begun to

fall rapidly and had already piled up six inches when I left school. My brother and I were

ecstatic to see this much snow so late in the school year. Our whole neighborhood came outside

to build snowmen, sled ride down the street, and have snowball fights. In the middle of all of our

childish fun, my dad kept leaving home and driving to check on his parents. He first checked on

his mom at her house, where my uncle had been living with her, then he drove to the assisted

living hospital where my grandpa was. The neighbors and I spent the whole day together and by

the time we all came in for the night my dad had not come home yet.

Early in the morning my mom came in to wake me. The room was so bright because of

the glistening snow outside of my window. I was happy that she woke me up so early because I

figured then I would have all day to go out in the snow again. As I started to get up she told me

that my grandpa had passed away that night. This news shocked me tremendously; I always

figured my grandma would be the first to go because I could see her brain function deteriorating,

whereas my grandpa always seemed strong. My response to the news was, “Has anyone told

grandma yet?”

My parents went over to tell my grandma what had happened. She was so far along in

the stages of Alzheimer’s that she could not retain that he had died. She did not cry, or smile, or

even react because she was only focused on what was going on in her life at that minute. She

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would ask them to hand her the T.V. remote and mentioned that she was hungry. My parents

decided they did the right thing by telling her, but that they should not try to force the

information upon her seeing as it would only hurt her.

Grandma sat in a chair at the funeral and smiled. She was happy to be getting so much

attention by friends and family members, even though she did not remember who they were.

People would tell her how sorry they were for her loss and she would reply by asking what she

lost. She saw my cousin Kim and I talking to each other and broke down saying that she was

seeing double and needed to go home. Even though it was my grandpa’s funeral I believe the

most painful part for everyone was watching my grandma’s confusion.

Alzheimer’s disease can affect anyone, regardless of their mental status or cognitive

abilities throughout their early life. Ronald Reagan was a very strong influence in United States

politics. He was the president, the largest form of control out of anyone in the entire country.

He had control over the military, the ability to veto bills, and to make decisions in foreign affairs.

No matter what political party someone is a part of, there is no arguing that the president holds a

position of high authority. Unfortunately, President Reagan was also diagnosed with

Alzheimer’s disease. Reagan’s son, Michael, explained that his father was physically well but

not capable of sustaining a conversation. Michael Reagan said in regards to his father’s

Alzheimer’s, “Not being able to have a conversation ..., but knowing that on the inside he knows

who we are is good enough for me" (Fournier). President Reagan’s diagnosis shows how anyone

can be affected by Alzheimer’s and that even famous families struggle with providing

Alzheimer’s care.

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Even though my grandma could not remember that my grandpa had died, she seemed to

be getting more and more depressed each day. She did not talk as often and started eating less.

When asked if she was alright she would just say yes and that she was tired and needed to sleep.

Depression is common in Alzheimer’s patients. A study was conducted in three hospitals in

Western Norway by doctors Lebedev, Beyer, Fritze, Westman, Ballard, and Aarsland where 53

Alzheimer’s patient’s depression symptoms were followed. Twenty-two of the patients were

given antidepressants and the remaining patients were not. At the end of the testing it was found

that the antidepressant use needs to be reevaluated because it did not provide enough information

on the benefits of Alzheimer’s patients taking antidepressants. Even in 2014 little is known

about how to treat an Alzheimer’s patient who encounters depression.

The biggest medical advancements in Alzheimer’s disease have been found in autopsy

studies. Peter J. Whitehouse, a Medical Doctor at The Alzheimer Center University Hospitals of

Cleveland and Division of Behavioral Neurology Case Western Reserve University Cleveland,

Ohio has studied results from autopsies to understand the neurochemistry of the brain. He has

found that Acetylcholine is the first chemical to change in an Alzheimer’s affected brain.

Noradrenalin and serotonin are neurotransmitters that affect behavior and cognitive ability. In

many Alzheimer’s affected individuals there is an abnormal amount of the amino acid glutamate

in the brain. The neuropeptides somatostatin and corticotrophin are consistently released at

different rates in patients with Alzheimer’s as opposed to people without the disease. Even

though autopsies have not provided researchers with enough information to cure Alzheimer’s it

is believed that Alzheimer’s is due to loss of neural synapses.

After my grandpa died my grandma was moved to live with my aunt at her house. Kim is

my aunt’s daughter and she visited her mom very frequently. After just beginning middle school

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I had never been so busy in my life, I stopped visiting my grandma as much as I had before. She

was in a new place and that confused her enough already, but when I did decide to visit her she

was a completely different person. She would scream when the doorbell rang because she said it

was a man coming to take her away. No one knew how to comfort her because she no longer

trusted anyone. Grandma believed my aunt bought poisoned food from the store and that

someone was constantly trying to break in to the house. My grandma’s growing paranoia scared

me and visiting her, the way she was, was too much for me to handle at twelve years old.

A study conducted by the International Journal of Geriatric Psychiatry states that

paranoia is a common symptom among some Alzheimer’s patients. The study showed that those

who became delusional were mainly people that were no longer married and have had more time

passed of being cognitively impaired. Researchers have developed multiple theories as to why

Alzheimer’s patients face delusions and depressions. One theory is that, “Paranoid phenomena

in AD can be explained as an adaptive response to a decreased ability to comprehend reality

owing to declining cognitive function”( Bassiony 554). To me this theory means that the patient

is unable to truly understand what is going on around them, so life becomes scary to them and

disturbs their thoughts. Another theory is “That one of the disorders is responsible for the other.

Delusions may be secondary to depression” (Bassiony 554). In my grandma’s case she became

depressed long before her delusional tendencies started occurring. My grandma was a prime

example of how Alzheimer’s induced delusions can cause paranoia.

For the next few months I only heard about my grandma through my dad, who sugar-

coated every detail. I knew my grandma’s mental state was deteriorating rapidly and because I

was young, I did not have to be around to watch her get worse. My dad would say how grandma

forgot who he was when he walked in the door, and would tell him to stay away from her, but

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how sometimes her memory would slip back and she would at least know that he was her son.

My aunt could not bear the thought of putting her disoriented mother in a nursing home, so she

cut back on her hours at work at constantly watched my grandma, much like my grandpa had.

My aunt Linda was beginning to look exhausted. Her hair was always a mess, as

opposed to her normal pin straight hair. She did not go out with her friends anymore, or even go

out to the grocery store because she did not think anyone else could handle my grandma. Aunt

Linda’s cousin, Cindy, decided to make dinner and desert to bring over to my aunt and grandma

one night in April of 2009. Cindy does not cook often but she loves making deserts. Cindy

prepared her pineapple cake that she often brought to family events. Cindy and Linda cut my

grandma’s piece first and Cindy walked it in and set it in front of my grandma on the table, while

she returned to Linda cutting the rest of the cake in the kitchen. Linda and Cindy got their cake

and walked in to the dining room, only seconds after giving my grandma the cake, to find her

choking.

Paramedics were called to the house and my grandma was rushed to the hospital. She

had suffered from an event called aspiration pneumonia. The altered state of mind that

Alzheimer’s disease brings upon the patient also can make the patient have symptoms of

dysphagia, difficulty swallowing, as well as a less reliable gag reflex. Aspiration pneumonia is

caused by food or vomit going in to the lungs and starting pneumonia. Sir William Osler, the

author of Principles of Practice and Medicine, referred to pneumonia as “’The special enemy of

old age’” (Kalia 37). Studies have shown that the main cause of death in Alzheimer’s patients

living in a nursing home is suffering from aspiration pneumonia or drastic weight loss.

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Alzheimer’s is a violently spreading disease that turns someone you love in to someone

who no longer has the ability to recognize you. It starts progressing slowly and no one ever

thinks that their family member will forget them. People believe their loved one will overcome

Alzheimer’s through the help of a close knit family, constantly supporting the affected

individual. Little is able to be done to treat a patient with Alzheimer’s, leaving families

indefinitely hoping for a miracle drug or surgery. The fear of the future does not only affect the

individual with Alzheimer’s but also the families and friends who become distant strangers to

their once close loved one.

On April 19th 2009, after ten days of

hospitalization in the intensive care

unit, it was apparent that my grandma

was not going to survive without

continued life support. Throughout the

ten days she could not talk, eat, or

stand. She was trapped inside of an

unusable body, the only thing she could do was move her hands. My brother was not old enough

to visit her in the ICU, but we managed to all go in to say our goodbyes on that tenth day.

Seeing my grandma hooked up to machines and have a feeding tube scared me at first but then I

was able to understand that under all of the medical equipment she was still my grandma and I

needed to say goodbye.

My grandma had not known me as my real name since I was eight. When I held her hand

for the last time she squeezed it. It was a gentle squeeze, but that was the only motion she was

able to make. In that moment it felt like my real grandma was back, the one who told stories

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about driving too fast down hills and who taught me how to read Peter Cottontail. She could not

talk or see but I could feel that she knew who I was, I was not Kim, or a stranger, I was her

youngest granddaughter, Alex.

Thirty minutes after leaving the hospital, on that perfect spring weathered Sunday, my

grandma had officially passed away. Only my aunt and uncle were in the room when it

happened but I know she was watching every single one of us on that last day. My grandma was

not a victim of Alzheimer’s that day, she was Betty Stevens again, and she knew who her family

was. I was relieved that my last memory with her was one where I could feel the grandma I

remembered from when I was a kid. As a family we felt closer to my grandma that last day,

those last hours, than we had in years, and none of us would have wished anything more.

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Untitled. 23 June 1996. Photograph.

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Untitled. n.d. Photograph.

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