Jun 27, 2014

Is the Progression of Decline in Alzheimer’s Patients the Reverse of Infant Development?

As my mother continued her decline from Alzheimer’s, it was disconcerting to ride the roller coaster of emotions. Wearing the daughter/caregiver hat I felt powerless to change the progression of her disease.

By Elaine C Pereira
Alzheimer's Reading Room

As an Occupational herapist I believe it is. People with Alzheimer’s decline backwards in the same sequence that children develop forwards.

Is the Progression of Decline in Alzheimer’s Patients  the Reverse of Infant Development

Most of my professional expertise as an Occupational Therapist has been in pediatrics. Although I also worked decades in adult rehab and home care, it’s the kids who stole my therapist heart.

As my mother continued her decline from Alzheimer’s, it was disconcerting to ride the roller coaster of emotions. Wearing the daughter/caregiver hat I felt powerless to change the progression of her disease.

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On the occasional times when my emotions were stable, I studied the neurological aspects of Alzheimer’s, which were both fascinating and bewildering. Through my eyes as an OT I could observe and evaluate Mom’s progressive neurological decay clinically.

Infant Maturation

Infant/toddler development is astounding! The neurological explosion happening every day as an infant’s head control grows stronger or they master separating their fingers from a fisted hand, first raking and then pinching a Cheerio; how their babbling steadily evolves into intelligible single words.

A month old will look in the direction of a sound. At 6 months he can pull off his socks, stand up holding on by 10 months and nod for “yes” by 12 months.

Eighteen month olds follow simple directions with increasing mastery. And between 2 and 3 years toddlers are independent with basic dressing, feed themselves, walk automatically and talk well.

Alzheimer’s Decline

My mother’s downward spiral from Alzheimer’s mirrored the sequence that infants/toddlers follow as they acquire new skills and move forward.

Higher executive functions and logical thinking started waning first, skills mastered in adulthood actually and not childhood. It was not an obvious downhill slide; more like a mishandled yo-yo in which consecutive up and down arcs got shorter until they completely fizzled out.

Mom’s next milestone of loss was the onset of a wobbly gait. The same woman who had previously pirouetted on one foot while literally kicking me in the butt with the other foot, started grabbing the handrail more frequently. Articulate speech dissolved into halting phrases as she searched for words in her brain’s language Rolodex. My mother’s skills had regressed to those of a 2 ½ year old.

With the passage of more time, Mom slid further backwards until she struggled to process simple directions, needed more self-care assistance, and couldn’t always complete the sequence of bringing a utensil to her lips. Circa 18-24 months developmentally.

As my mother’s neurological abilities continued to decline, she could barely walk and only then with considerable assistance, couldn’t follow any verbal directions and stared at a cup without bringing it to her mouth. A one year old had more skills!

After that, Mom just disintegrated! She mumbled, played with the strings on her shoes or robe, ate and drank very little as she mysteriously started to assert her control over her destiny according to hospice.

Three Pounds Of Extraordinary Power

The adult brain on average weighs 3.3 pounds, about the same as a half gallon of milk. But this light weight is no light weight! The brain is the central command center for everything we do! We think that life ends when the heart stops but in fact it’s really our brain.

Natural differences not withstanding, there are seven stages of Alzheimer’s decline. The seven stage framework or Global Deterioration Scale was developed by Barry Reisberg, M.D., clinical director of the New York University School of Medicine's Silberstein Aging and Dementia Research Center.
From I Will Never Forget:
Dementia’s “insatiable appetite for brain cells… (causes the brain to be) chipped and chiseled away piece by piece.”
And as each “piece” of the brain quits functioning, so does the ability that it regulates, be it walking, talking or swallowing.

Just as being the parent of a toddler requires extraordinary patience, and a mop, as the little child scientist experiments with gravity by pushing his cup to the floor yet again, so do caregivers of those with Alzheimer’s.

As their “cups” topple over in emptiness, everyone must show patience, and bring a mop too if necessary.

leaving them in emptiness

I Will Never Forget

Elaine C Pereira, is the Award Winning author of the Best Selling memoir, I will Never Forget: A Daughter's Story of Her Mother's Arduous and Humorous Journey Through Dementia.

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Original content the Alzheimer's Reading Room