Two articles in the New York Times caught my eye this month. The first, by Fredrick Kunkle, discusses Alzheimer's disease and gait. He states, "The way older people walk may provide a reliable clue about how well their brain is aging and could eventually allow doctors to determine whether they are at risk of Alzheimer's." After studying thousands of older people from around the world, researchers found that individuals whose walking pace slows are most likely to have cognitive complaints and are more than twice as likely to develop dementia within 12 years. Patients whose gait declined for other reasons such as arthritis and ear infections were ruled out in the gait/dementia relationship.
I recognize the shuffling gait of individuals with Alzheimer's and other dementias, but I never thought to watch walking speed over a long period of time as a signal of mental slowdown. Both my mother and sister Carole had the noted walking form as their feet slid along the ground at a sluggish pace, but I had not thought about this connection with brain malfunction. It makes sense. Although most of us find walking to be an automatic process, placing one foot in front of the other and moving forward; it is actually a complicated balancing procedure. Babies work hard to be able to walk without toppling; adults too often become wary of steps, loose gravel, frayed carpet, and other potential hazards. Maybe there are signs of dementia in this caution.
Carole's shuffle also included a left-leaning pattern, as she made ovals around the family room. Caregivers guessed that the lean came after a mini-stroke and became worse as other strokes ensued. She did walk slower as the days of the disease wound their course. It is an interesting consideration and worth a moment of contemplation as you watch a loved one that you fear has slipping cognition during her daily walking route. Of course, only a trained neurologist can diagnosis Alzheimer's, but your observant eye can be most helpful.
Kunkle's article also reported a connection between dementia and sense of smell. A loss of the olfactory is a familiar indicator of mental decline, but this can also come from many other factors as well. Just because the cookies are burning and you do not notice the smell does not mean you have Alzheimer's. Stuffy noses happen. However, if the cookies are burning because you completely forgot about them including having driven to the store to purchase ingredients and then diligently following a favorite recipe minus the eggs, flour, and sugar, substituting talcum powder and kitty litter instead. Now there is a concern.
Another indicator of Alzheimer's disease is the inability to swallow. Typically this occurs in the late stages when the complicated workings of throat muscles fail to move food and liquids to the stomach. Instead these end up in the lungs resulting in pneumonia from aspirated food. This can cause oxygen levels to drop and make breathing difficult and inadequate.
Dr. Jessica Nutik Zitter shares her experience in caring with such patients whose pneumonia leads to antibiotics and life support to improve health even though mental faculties are deeply and irreversibly impaired. Better health returns the individual to regular food and drink, again with the increased risk of failed swallowing and food aspiration leading to - yep, another bout of pneumonia. "Our medical system deals well with organ dysfunction... if there is trouble swallowing, we can bypass the throat with a feeding tube that goes through the abdominal wall directly into the stomach. But contrary to popular belief, a feeding tube does not prolong life in a patient with dementia. It actually increases suffering. A stomach full of mechanically pumped artificial calories puts pressure of an already fragile digestive system, increasing the chance of pushing stomach contents up into the lungs." Dr. Zitter continues with possible complications: dislodgments, bleeding and infection as well as depriving the individual of the last bits of human experience, taste, smell, touch, and connections to loved ones.
Denying heroic measures like life support and feeding tubes is a horrific decision for family. As death nears and a loved one steals away, it is overwhelming to acknowledge the end rather than prolong life. Losing someone you love is torturous. Dr. Zitter adds, "In the face of death, food and hope are highly seductive. But once again I [wonder]: Does our need to feed our dying loved one blind us to what's really best for them?"
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