Managing Alzheimer's Patients

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Science  18 Dec 1998:
Vol. 282, Issue 5397, pp. 2194
DOI: 10.1126/science.282.5397.2194c

Behavioral interventions are important in the management of patients with Alzheimer's disease, as reviewed by Marcia Barinaga in her News Focus of 6 November (p. 1030). We do not agree, however, with her emphasis on the conceptual model of “regression toward infancy…backward march through development.”

Alzheimer's patients are not children, despite superficial similarities. The physiological processes of learning in childhood and of skill loss with Alzheimer's disease are not the same. Learning in childhood is related, in part, to myelination of white matter tracts, but the dementia of Alzheimer's disease is not caused by demyelination, but by amyloid β protein deposition and loss of neurons and synapses. Moreover, the psychological processes underlying behavior in children are not the same as in Alzheimer's disease (for example, children often fail to cooperate because of inattention, Alzheimer's patients may not cooperate because of inability).

Each Alzheimer's patient has a lifetime of experiences that determines their unique set of human qualities, qualities that are not lost, even as the memories of these experiences are lost. To see Alzheimer's patients as recipients of “developmental age appropriate activities” is to see them defined by their incapacities and not by their distinctive human qualities. To view Alzheimer's patients as children is to deny their individuality (1).


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