pink elephant

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At a very young age I always knew I wanted to be a doctor or a nurse. I remember playing “doctor” with my dolls and when preparing to take my test as a certified nursing assistant I practiced on my little sisters and took my parents blood pressures as often as they would let me. When I received my certification I started work at a nursing home in Greeley Colorado. It wasn’t any different from the clinical hours I completed while taking my C.N.A courses except, I was able to develop a relationship with my residents. I worked at this nursing home for two years during which I saw a variety of different diseases, dementia, sun downers syndrome, and Alzheimer’s disease. By the time I left the nursing home, to start a job with a private client, more than half the residents that were there when I started had passed.

My new client had a different case of Alzheimer’s which make you think she didn’t even have the disease but maybe schizophrenia with dementia or another disease undiagnosed but, her doctor’s insisted on Alzheimer’s with maybe some signs of schizophrenia, that may explain her unique behavior. Alzheimer’s can be very complex but with my background in the nursing home and a few biology and pre-nursing courses, I had a good understanding of what the disease is and a few of the causes during the disease.

There are three parts to your brain the cerebrum, controls movement and is involved in remembering, problem solving, thinking and feeling. The cerebellum controls coordination and balance and the third part of your brain is the brain stem which, connects the brain to the spinal cord and controls automatic functions (breathing, digestion, heart rate and blood pressure). The cerebral cortex is a structure within the brain that plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. When these systems began to fail the mind and body loose complete control, and your life, as you know it, beings to fade. Among some of the problems associated with brain disorders is Alzheimer’s disease. A disease that leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.

In the adult brain there are about 100 billion nerve cells or neuron branches that connect at more than 100 trillion points. These nerve cells and connections create cell signaling which create tiny electrical charges that signal to form memories and thought movement through an individual nerve cell connecting together at synapses. When a charge reaches a synapse, it may trigger release of tiny bursts of chemicals called neurotransmitters that travel across the synapse, carrying signals to other cells. In an Alzheimer affected brain, neurons are the chief type of cell destroyed, disrupting both the way electrical charges travel within cells and the activity of neurotransmitters. The cortex shrivels up, damaging areas involved in thinking, planning, and remembering. Shrinkage is especially severe in the hippocampus, an area of the cortex which functions in formation of new memories. Ventricles, fluid-filled spaces, grow larger, and abnormal clusters of protein fragments build up between nerve cells. These dead and dying nerve cells contain tangles, which are made up of twisted strands of another protein.

Our time and our experiences create patterns of activity and explain, at the cellular level, how our brains code our thoughts, memories, skills and gives a sense of who we are. Specific activity patterns change throughout life as we meet new people, have new experiences and acquire new skills. The patterns also change when Alzheimer’s disease disrupts nerve cells and their connections to one another. Sciences are not absolutely sure what causes cell death and tissue loss in the Alzheimer brain. Doctor’s can only make a diagnosis of “possible” or “probable” Alzheimer’s Disease while a person is still alive. The only true diagnosis is through autopsy which revels the dramatic shrinkage, especially of the cortex and through a microscope doctors are able to see the widespread fatty deposits in small blood vessels, dead and dying brain cells, and abnormal deposits in and around the brain cells.

When you spend eight, twelve, and 24 hours days with an AD patient you begin to see their cognitive functions increase and decrease each day. One day someone may remember how to brush their teeth and hair and the next become extremely confused and try brushing teeth with their hair brush and hair with a toothbrush. My new client had an extremely unique case of AD. She was in the very last stages of the disease which suggest that her brain was almost completely gone. Her mood and behavior were very child-like and was extremely talented in masking this behavior. A complete change would occur when we were in public or when a visitor came over. This was a completely different experience for me, for I was used to child-like behavior and withdrawal from friends and family. In my new client’s case she changed in personality and behavior and engaged in cover-up around old friends and family. There were no signs of her showing any symptoms of the disease. She maintained her eyesight, mobility, was able to perform familiar tasks.

Most AD patients are aware of their decreasing ability of cognitive function but Jane was in complete denial and became excessively upset when told she had AD. Her doctors have suggested some schizophrenia and still insist in her diagnosis of Alzheimer’s. Jane was a fan of hovering with some tendencies to nag and pick out every little detail while I cleaned or did any kind of work around the house. This was very irritating but may have been due to her OCD behavior and often treated me and other caregivers as servants. I was often bossed around and told to complete tasks beyond ridiculous: iron sheets, re-making her bed until perfect or until she reached satisfaction, washing dishes before putting them into the dishwasher. While tending to her garden (as a favor) she would often make me show her the root of the weed to make sure I got the entire thing out of the ground, if not, she’d tell me to dig up the rest.

She had the tendency to make fun of overweight people, engaging in laughter and very inappropriate in public saying, “Would you look at that,” and “My, that is gross,” usually laughing while saying these things. Often she engaged in conversations with herself or with someone she claimed was in the room. These conversations often took place alone in her bedroom and while in bed before falling asleep and sometimes during the day. Before beginning this job I was told that people often heard strange noises during the night and saw strange shadows throughout the house and her daughter mentioned feeling her father’s presence in the house. When asked who she is speaking to she laughs and says, “Well, you know” and goes off on a completely different subject.

She had some random, “upset”, outbursts. She would grow angry about something unknown, usually seen on television. “That just makes me so angry” and hit’s the arms of her chair. Even when nothing on television is showing that would set off hostile behavior. Although Jane was sometimes difficult to deal with she was often very happy and very fun to work with. I enjoyed my time spent with her and gained all more experience with working with the elderly and with Alzheimer’s disease (or a disease unnamed).