June 2, 2003
When painter and high school art teacher Wanda Lu (not her real name) was forced to retire in 1995 at age 52, she could no longer remember her students' names. This low point had arrived after years in which she had had increasing difficulty with grading, lesson planning and remembering day-to-day tasks. She was the victim of a rare brain disorder called frontotemporal dementia that, like Alzheimer's disease, causes progressive loss of memory and everyday functioning. In her case, the malady strongly affected a part of her brain controlling language and organization skills.
For Ms. Lu, however, a strange thing happened. As her memory and mental abilities declined, her artistic talent seemed to blossom. Before her illness, she tended to paint landscapes and figurative works using either a Western representational approach or in the brush style of her native China. As her illness progressed, though, she began merging the two styles, creating artworks of striking originality and power.
"We typically don't think that something could be getting better, we only think about what's getting worse," said Bruce L. Miller, MD, of the University of California, San Francisco, who described this case in the May 27, 2003 issue of the medical journal Neurology. "Now I always ask if there's anything patients are doing very well, or better than before. It's a remarkable response to a dementing illness."
Strengths-based Skills and Memory Coaching
The relentless slide of Alzheimer's and others forms of dementia is devastating for patients and the people who care for them. Still, as Dr. Miller's case reminds us, unique skills can persist and even flourish. While nurturing these inner strengths will not halt or reverse the disease, they may be comforting to the patient. They may also aid in countering some of the combative behaviors and agitation that often arises, experts advise.
"Alzheimer's care has become more 'strengths-based' in recent years, reflecting a change in how health-care practitioners look at the families and the person with the disease," says Robin Fenley, director of the Alzheimer's and Long-Term-Care Unit of the New York City Department for the Aging, "In other words, determine what the person can do and what skills they do retain, and then give them tasks to encourage the types of activities that will keep those skills as sharp as possible for as long as they can."
As a very simple example, she suggests that if the person has been used to folding clothes, that they be encouraged to continue this task instead of taking this 'job' away from them. "Empower the person with Alzheimer's to do the things they can do," she says.
Memory coaching, in which specific daily tasks are taught and rehearsed, is another approach that caregivers can adopt to help people with Alzheimer's revive forgotten skills.
"In the early stages," advises program co-director Sunny Kenowsky of the Fisher Alzheimer's Disease Education and Resources Program at New York University Medical Center, "we can teach a patient to brush their teeth, exercise and do some of those things that they can no longer do. In the middle stages, we can teach them to eat with a knife and fork, for example, or it can help with incontinence. And in the end stages we can help people with walking and learning to sit up independently."
The earlier in the course of the illness such approaches are tried, researchers report, the better the results. But unfortunately, like the drugs currently available to treat Alzheimer's, they provide at best temporary respite.
For more information on these and other approaches to Alzheimer's care, contact the Fisher Center for Alzheimer's Research Foundation at 1-800-ALZINFO, or visit www.ALZinfo.org.
By Toby Bilanow, Medical Writer, for www.ALZinfo.org. The Alzheimer’s Information Site. Reviewed by Samuel E. Gandy, M.D., Ph.D., Chairman of the Scientific Advisory Board, Fisher Center for Alzheimer's Research Foundation.