How can you keep yourself from fantasizing

4. Course of the disease

4.1 Onset of illness
4.2 Progressive disease
4.3 Final phase of illness

4. Course of the disease

The following description relates primarily to the typical course of Alzheimer's disease.

In Alzheimer's disease, the nerve cells in the area of ​​the hippocampus, an area of ​​the brain that is very important for memorizing and remembering memory contents, are affected early. That is why problems of short-term memory and learning are often at the beginning.

In the case of vascular (circulatory-related) dementia, the impairments occur in a similar way, but depending on the focus of the circulatory disorders, individual symptoms can occur in a different time sequence and the mental state can be subject to greater fluctuations. For example, changes in the emotional state and changes in personality or impairment of the ability to make judgments can occur very early, while memory disorders may not come into effect until later.

If dementia begins more strongly in the frontal areas of the brain (fronto-temporal dementia), severe speech disorders, agitation and possibly impaired judgment or hallucinations often occur at an early stage.

Even with Alzheimer's disease, individual symptoms can occur in different chronological order. In some patients, for example, impairments of language and ability to act become apparent early on, while memory disorders appear later in the course.

The three phases of the disease described below will each go through over the course of one to an average of three years.

4.1 Onset of illness

At the beginning of Alzheimer's disease, impairments in the following areas are usually in the foreground:

  • the Short term memory (remember what happened recently),
  • the Learn (memorize something),
  • the Orientation skills (find your way spatially and temporally),
  • the planned action (to do something in the correct order and coordinated),
  • the Information processing (Correctly absorb, assign and link information with one another)
  • and partly also the language (Word-finding disorders).

Usually these abilities start to decline gradually. For example, a transfer slip can no longer be filled out correctly, although this has been done regularly and frequently since then. The usual small repairs in the house are no longer possible for a skilled person, or an experienced housewife is no longer able to cook dishes that require several coordinated steps. It is also typical that things are constantly being misplaced, deadlines can no longer be met and orientation in an environment that is not entirely familiar is easily lost.

Many of these changes are initially difficult for laypeople to distinguish from age-related decline in learning, concentration and attentiveness. A frequent and quite plausible explanation for forgetfulness and other mental performance restrictions is that the person in question is currently challenged or impaired by emotional stress or external demands. In fact, psychological and mental stress can at times lead to clear mental limitations such as lack of concentration and forgetfulness. Older people in particular often react very clearly to stressful situations, as they have less mental reserves to compensate for stressful situations. For example, a change of location and apartment can temporarily lead to noticeable disorientation or even confusion in an elderly person. Likewise, a changed life situation, for example after the death of the partner, can require great intellectual adjustment efforts.

Emotional stress, such as a strong grief reaction, can lead to mental limitations in such a way that the thoughts only revolve around one topic and other things are hardly absorbed. In the case of pronounced depression, accompanying symptoms can be a considerable slowdown in thinking and a high degree of lack of concentration.

In order to decide whether mental stress leads to mental impairment in a person or whether the onset of dementia is responsible, the advice of an experienced and competent specialist must be sought.

The seemingly sudden onset of dementia often indicates that disease changes and psychological factors as described above are interacting. The onset of dementia often does not show itself to the outside world for a long time, as long as life goes on in the usual rhythm and no special demands are made. Errors and impairments that occur nevertheless often go unnoticed.

When there is a change in life, which however makes it necessary to adapt and readjust, or when psychological stress occurs, the limits of mental performance become evident and the symptoms of the disease appear. For example, this may be the case with a temporary hospital. The slightly ill person in the hospital lacks orientation in the familiar environment and the daily routine they are used to at home. This can cause sudden confusion and disorientation. When the person comes back home, the impairment usually subsides after a short time. The unexpected death of the spouse, for example, can, in addition to the emotional burdens that the event brings with it, demand a high level of mental adaptation, which a slightly ill person can then no longer cope with. Grief over the lost person or an emerging resigned attitude can exacerbate these difficulties. Often, even during his lifetime, the deceased, spiritually vigorous partner took over tasks and responsibility for the partner suffering from dementia, step by step, without this being noticed by both or outsiders.

Even before the actual mental limitations become apparent, people with dementia often fall Changes in behavior on. For example, a sociable person withdraws increasingly because he can no longer follow the conversations in a group. He experiences such situations as uncomfortable and overwhelming and may have the feeling that the others are not included.

Another person becomes irritable because activities that he was able to cope well with some time ago now cause him great effort. For example, cooking, shopping, doing simple arithmetic, meeting deadlines and other things suddenly demand a high level of concentration. The patient becomes dissatisfied with himself and his performance or tends to blame others for the causes of difficulties for which he cannot explain himself. For example, he accuses people close to him, such as his own spouse, of misplacing things. Of course, he is not aware of any error and feels wrongly accused.

Depressive moods are relatively common in the first phase due to the many limitations and incomprehensible changes in daily life.

The sick usually begin to protect oneself intuitively from exposing experiencesby avoiding them or interpreting them differently. For example, they see the larger sheet metal damage to the car, which they report to their wife at home, not as a result of their own driving error, but as damage that was probably caused by a stranger who also ran away undetected. Such interpretations are suggested by the already impaired and unstable memory capacity at this stage. In addition, the experience made is often in clear contradiction to one's own self-image. After all, people have always driven carefully and without accidents over the past 30 years. As a result, a third-party negligence formally imposes itself as an explanation of the cause in one's own imagination. And ultimately, the patient's usually already latent fear of loss of self-worth and competence at this stage leads to their own mistakes and mishaps being faded out of perception and memory.

So you can also understand that, for example, a tidy person cannot think of constantly relocating the apartment key himself. It can only be that someone else is responsible for these errors. If someone wanted to convince him or claim that he was making these mistakes himself, he would have to defend himself vigorously and might have to accuse whoever does so that he has dishonest intentions and wants to denigrate him. He becomes suspicious or negative of him.

Incidentally, not only people with dementia tend to adapt memory images to their own ideas or convictions. Today we know from memory psychology that memories are not statically stored data, but are constantly changed by internal evaluations or external influences. The saying, “If you just talk yourself into something long enough, you will finally believe it” suggests this. We all know the experience that certain beliefs prevent us from seeing or accepting things as they actually are. In dementia sufferers, this human reaction is intensified due to increasing mental impairments and the fear of exposure and loss of self-esteem.

Furthermore, it is a basic tendency of people to create consistency between their own experiences, values ​​and their own self-image. What we cannot explain, we seek explanations for it. People suffering from dementia spontaneously find explanations for their own behavior and events that they cannot explain to themselves at first. Or they sometimes seem to make up stories made up of bits and pieces of memory and their own imagination. For example, parts of the memory of a recent family outing and memories of a school trip in childhood are linked together in such a way that a coherent story emerges (one then speaks in technical terms that the sick "confabulate"). When the patients tell these “stories” several times, they are more and more convinced that it happened exactly that way.

From this understanding, two important basic orientations arise when dealing with dementia patients: Firstly, we should confront the patients as little as possible with their own deficits and not correct them so that they do not feel embarrassed and are constantly aware of their limitations. Instead, we should try to support them without fuss when we can, even without them noticing the help as such.

Second, people with dementia need a lot of recognition and encouragement. Because even if they no longer fully recognize their own deficits due to the increasing mental impairments, they still perceive the limitations of their abilities in the here and now, perhaps also those of which they were proud in the past.

Through the Loss of inner support the sick often suffer from Fears. When the world is no longer what you expected it to be and the internal order is just as confused, it makes you insecure and creates fear. This fear is usually difficult to assign and is sometimes perceived as an existential threat. It is therefore easy to understand when people with dementia develop, for example, fear of losing their partner or of a possible impending disaster. Ultimately, they seek causes for the vague feeling of fear that arises in them. The fear of dementia sufferers of losing their own savings or the suspicion of impending theft is understandable. If you lose track of your belongings and feel insecure, try to hide your money in a safe place within easy reach. However, if you forget after a short time where you have brought the values ​​to safety, uncertainty arises again. This can lead to a cycle of increasing uncertainty. You may then also think of theft if you at least remember that you had a large amount of money with you. The police may be asked to help investigate the matter.

Other sick people do not fear losing money and thus the basis of their own livelihood; on the contrary, they begin to give away money or to spend it more. In this case too, however, it is basically a matter of a similar mode of reaction. Sick people who seem to give away money unreasonably to others often try to support their own self-esteem and to rally well-meaning people around them. Again, fear, in this case of loss of self-worth and loss of recognition by others, is an important driving force behind behavior. In addition, a reduced ability to make judgments due to illness can lead to a loss of a realistic assessment of the value and importance of one's own wealth.

A different way of reacting can develop out of the need to contact other people, especially close relatives, check to want and to determine over them. Especially people who were used to certain behavior in the past can tend to react like this in order to regain security and control over the situation and their life. Here, too, the fear of unpredictable changes and an experienced internal and sometimes external loss of control basically trigger the behavioral tendency.

Other people too withdraw more and morewhen they notice that they can no longer cope with many things or that they feel overwhelmed. This can go so far that they isolate themselves completely and avoid contact with other people. You avoid difficulties so as not to fail and thereby avoid exposing yourself to others. Still others, who live in the family community, try to avoid overwhelming situations by feeling very strong reserved, adjusted or inconspicuous behavior. Complaining about pain, illness and ailments can also be a way of avoiding, for example, having to go to a birthday party where one is afraid of being overwhelmed or exposed.

Many of the behavioral tendencies of people with dementia are easy to understand on closer inspection and fears and fears are often the origin of different ways of reacting.

The Search for stability and security especially with familiar people, which usually increases in the first phase of the disease and often becomes an important need for the sick, is often accompanied by a tendency in the opposite direction. It is the simultaneous need for independence and self-reliance in order to support or maintain the injured self-esteem. This was once called the by a book author "The double message of dementia" designated. On the one hand, the patient wants help and it may also be necessary, but at the same time he is afraid of being patronized by others and of losing a piece of independence and control over his life. Caregivers need creativity, empathy and diplomacy to deal with these contradicting tendencies. Help is then best given inconspicuously so that it does not appear to the sick person to be an aid at all. You can say to the patient, for example, that you just want to “do him a small favor”, which he “could of course do himself” or you can give the help under the “necessary guidance of the patient”, which supports his self-esteem.

The search for stability and security can sometimes also lead to sick people seemingly playing off their relatives against each other. They try to secure the attention of a loved one by making other relatives bad in front of them or by reporting that others are neglecting them. (Of course one should not always regard such statements by the sick as unjustified.) It would be wrong to moralize the sick in such situations. Rather, it is crucial to perceive your need for security and affection and, if possible, respond to it without criticizing your behavior.

The increasing mental limitations mean that the sick are less and less able to include the needs and context of other people in their considerations. For example, the mother with dementia can take it as a natural request that the daughter should stay with her in the future so that she does not feel so alone. She is no longer able to compare her own wishes with the needs and life situation of her daughter.

Relatives can be greatly restricted and overwhelmed by the patient's need for constant presence and willingness to care.It is therefore very advisable to distribute tasks and duties towards the sick person to different people at an early stage. In the early stages of the disease, the patient can usually adapt even better to the change of caregivers and is then more used to this in the later course of the disease. Therefore, relief offers such as care groups for dementia sufferers are very useful (see chapter "New ways in the care of dementia sufferers").

Since the patients understandably behave defensively against such new situations and projects, it is often advisable to introduce such innovations more casually and diplomatically. For example, you can simply invite the sick person to go to some nice people to have coffee instead of trying to convince him that he should go to a group for the elderly every Monday afternoon from now on. In a very similar way, you can, for example, introduce a helper who is to look after the patient once a week in the future as a nice lady from the neighborhood who comes "once" to visit coffee.

Too detailed information or a discussion in advance can lead to the patient developing unjustified fears or apprehensions, possibly believing that they will be deported or simply being overwhelmed by the information.

Sometimes a little pressure and perseverance towards the patient may be appropriate to overcome an initial inhibition threshold, so that an important offer of relief can get underway. Experience shows that as soon as the patient has become more secure and used to the new situation and trust has developed towards people who are still strangers, the patient's insecurities and fears also decrease. In a care group, for example, the relative can come with you for the first time and thus offer the sick person security through a trusted person.

An important prerequisite for a suitable offer of relief is of course that the environment is appropriate for the patient and that the carers are able to adapt to him.

The supervisors have to focus on ongoing fluctuations the current condition of the patient. While dressing in the morning works independently on one day, the order of the clothes may be mixed up the next day.

People close to you, such as your spouse or daughter, are often your most important caregivers. It is not uncommon for these caregivers to be most often in the field of fire of allegations by the patient. The threshold for letting another person feel their own displeasure about the impairments they have experienced is often lowest with people who are close to them. It is therefore important not to take such allegations or attacks personally. Understanding that this may only provide a valve in this way makes such accusations easier to bear.

Limits must, however, be set if others are harmed or the patient increases himself into uncontrolled behavior. This does not relieve himself, but puts himself under further psychological stress, which can increase his willingness to be aggressive. The sick are then sometimes difficult to access and can hardly be influenced. If a calm diplomatic approach does not help, a clear, determined demeanor that sets limits and is directed against the aggression and behavior (but not against the patient) may be necessary and helpful. Another option is to withdraw and wait for the patient to calm himself down. In very difficult situations, a doctor must be called for support if necessary.

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4.2 Progressive disease

Based on the disturbances of the short-term memory and the temporal and spatial orientation (confusing the times of day, not finding the way), the memory of the last years and decades becomes increasingly fragile as the disease progresses. The sick can then be of the conviction that they are forty years old or younger and that they have to go to work right now, since in some cases adolescence and early adulthood are most present. They live more and more in their memory world. The supervisors have to adjust to this world, because only in this way can they find an understanding approach.

The sick can no longer or mostly only temporarily adjust to the point of view of others. For example, the spouse should not reprimand the sick person if he is not addressed as a spouse but as a father or mother. At this moment the patient lives in the world of his memory and may perceive himself as a child or adolescent. Basically, he can only see the person who is, from his point of view, much older but familiar as a father or mother. Perhaps he also has a need for security and protection, which the association father or mother also suggests.

In this situation, the spouse could either accept the patient's point of view without reinforcing it himself, or he could cautiously try to address memories from the patient's recent past so that the patient recognizes him as a spouse again by himself. At the same time, he could give him security and security on the emotional level.

The Language as well as the ability to act and plan of the sick are usually restricted more and more. Simple courses of action such as using a key can become an insurmountable problem. For example, the patient no longer knows whether the key must point upwards or downwards when it is inserted into the keyhole. Later, for example, dealing with a knife and fork or climbing stairs cause difficulties. The so-called visual-spatial coordination of movement sequences, i.e. assessing how the leg is to be moved in order to reach the next step, can cause problems. Likewise, distances and the spatial depth of objects can sometimes no longer be correctly assessed. In this way, pictures and the television picture may be perceived as real things or people. The encounter with one's own reflection in the mirror is sometimes perceived as an encounter with another person and you begin to have a friendly conversation with the other person or perhaps want to throw him out of your own bathroom angrily, since a stranger has no business there.

The Vocabulary and language skills are kept increasingly simple. Often filler words like "the thing" or words that sound similar in language are used to name something. Verbal communication can ultimately be limited to a few words or short sentences. In this phase of the illness, facial expressions and gestures, i.e. the non-linguistic communication options, are of particular importance. The sick respond to the tone of the voice, a friendly handshake, or a smile. They communicate with their senses and their body language.

fears In front of devices, in front of water, in front of unfamiliar people and in the dark can occur comparable to the fears that children have about unknown situations or things that they cannot classify. Darkness can be frightening, as the sick do not know where they are or why it is dark when they wake up in their own room. The sick live in the moment. What you perceive and feel at the moment is crucial for you. They cannot foresee that it will be light again in a few hours and they cannot remember that they went to bed in the evening in which they now wake up at night. If you hear your spouse breathing calmly next to you, you may suspect that it is bedtime and everything is fine.

The sick can no longer plan their daily routine or certain activities in advance. They are guided by their habits, such as always reading the newspaper at breakfast (even if they can no longer understand what they have read).

The things in their environment animate them to activities. For example, a piece of cake that comes into view can encourage the patient to eat it even if he is not hungry, or a door stimulates him to open it even though he had no intention of doing it at first Leaving space.

Instantaneous thoughts and memories can also lead to certain actions. For example, during an afternoon of dancing, a sick woman remembers that she used to have to go home straight away after the dance lesson. So she politely says goodbye to her dance partner and says that she urgently needs to go home.

In this phase, the sick often look for them spatial proximity of a group or of caregivers. They are usually very affectionate and need security and security in a familiar social environment. They only withdraw when they are uncomfortable in a social situation, e.g. when it becomes too loud or too restless for them. Or, if you are busy with something, e.g. clearing a closet, your interest in other people takes a back seat. Pronounced tendencies to withdraw into the intimacy and privacy of your own four walls, as can occur in the first phase of illness, are now rare.

The sick no longer perceive their deficits as clearly as in earlier phases of the disease. you live in their world, in which the simple handling of an object, the collecting of things that they consider useful or valuable, or walking with another person and loving mutual contact are just as meaningful as, for example, professional activity or daily care for the family. During this time, some sick people also lovingly take care of stuffed animals or dolls or have meaningful conversations in their own gesture-supported language with people who are obviously only present in their imagination.

Sometimes you can see them in deep conversation with other sick people. In doing so, they react primarily to the tone of voice and individual words of the other and respond quite naturally and with involvement as if they had understood every word. The non-linguistic parts of the conversation are now in the foreground and are well coordinated. (According to a scientific study, 80% of healthy people also talk on the non-linguistic level!).

The behavior of the sick increasingly resembles that of Children, although one must not confuse the sick with children or simply treat them as if they were children. They still have memories of their adulthood. Values ​​acquired in the course of life and deeply anchored traits and life experiences can still be present and meaningful for them. They therefore also perceive it as uncomfortable and inappropriate to be treated like an underage child. Of course, this does not exclude attentively and lovingly responding to needs that appear childlike, which the sick show. For example, when they want to be taken by the hand or when they like to be caressed and caressed.

A second important difference between the sick and children is that the sick cannot learn and develop in the same way as children. For example, they cannot learn to control their impulsive behavioral responses such as anger or aggressive outbursts. On the contrary, they are less and less able to control such behavioral impulses and usually react spontaneously and immediately.

It is therefore wrong to try to “educate” people with dementia to behave appropriately. People with dementia are not children who learn to find their way around the world, but rather sick people who have lost control of their behavior.

The Emotional world, music, movement and the simple, direct forms of dealing with one another become important ways of accessing the sick. The voice becomes a means of communication and mediator of social closeness through its sound and the way it speaks.

In this phase, people with dementia can perceive vibrations on the emotional level in their environment particularly well. Since they can only rely on this level to perceive their social environment and are much less preoccupied with thoughts, conversation contents and ideas than we are at the same time, they concentrate entirely on what they directly experience, perceive and feel. They perceive their surroundings more emotionally. As a result, they sometimes appear thinner-skinned and can react more sensitively to mood swings and changes in the social atmosphere in their environment. They may react to the inner tension of a supervisor, who is under time pressure or is not fully focused on the subject, with resistance or withdrawal.

Seen in this way, people with dementia can sometimes be compared to a mirror for their own well-being. Before you even notice that you are restless, tense or stressed, the patient may already show this clearly in his behavioral reactions.

The sick usually react immediately and directly. They are unable to first examine and reconsider their fears and withhold spontaneous reaction tendencies. They leave when they are afraid, look for their home when they feel lost, thrash out when they feel threatened, and cry or laugh spontaneously when something touches them accordingly. In this respect, they behave very “real” and directly. In some cases, caregivers see a special quality in dealing with people with dementia whom they appreciate. On the other hand, this also brings with it special challenges. The carers can only expect a very limited control or regulation of their behavior from the sick.

4.3 Final phase of illness

In the last phase of the disease, the Ability to move increasingly restricted. At first, coordination or balance problems can arise when walking, later walking and finally longer standing becomes difficult overall. The sick often sit or lie down, as sitting upright can also be difficult. Contact with the patient can be established primarily through voice, touch and eye contact. Over the course of time, the patient may appear unresponsive or absent. The physical condition is at this stage overall weaker and more unstable. This can lead to infectious diseases that may lead to the dying phase. Sometimes, even in this phase, patients show astonishing reactions for a short period of time, such as a suitable answer to a question, a friendly, familiar smile or they make relevant information about their own state of health.

Since the patients lie a lot during this time or sit immobile and have little opportunity to stimulate themselves, stimulation from outside is particularly important via the senses. Instead of constantly having to stare at a white ceiling, for example, colorful posters can be attached with adhesive tape or a mobile can be hung that moves. Various objects can be placed in the hand or tied to the bed or reclining chair for touching and grasping. Care must be taken that the objects cannot be easily swallowed or torn. Colorful, stable scraps of fabric, sandbags, soft little balls that are given in the hand, or colorful play equipment such as is offered for toddlers, may be suitable. From time to time pleasant music can be played on a CD device or something can be sung to the patient. If there is time for personal attention, light massages (e.g. gently stroking along the arms and legs), if necessary with oils, as well as gentle passive movement exercises can be carried out. A relaxing bath can also be a positive experience for the sick person. However, care should be taken to ensure that the patient is transported to the bathroom without jerky movements or loud noises, which can be very frightening for the patient. General personal hygiene can mostly be carried out in bed. This is the least burdensome for the sick person.

Possibilities and ways to gently stimulate the senses can be found in books on the subject of "basal stimulation".

If the sick person cannot ingest food and liquid through the mouth either alone or with the support of other people and it can be assumed that this is not a temporary state of weakness, decisive questions arise as to how to proceed. It is very similar if another serious illness occurs in the last phase of the illness, which can lead to death in the short term. Then it must be clarified whether all treatment options offered by modern medicine should be exhausted.

In this phase relatives come to the decision, together with the doctor, to forego life-prolonging measures such as artificial nutrition and to limit medical treatment measures to avoiding states of suffering.

Refraining from giving food and fluids because the patient can no longer take them even with the most patient efforts does not have to be viewed as a refusal of necessary help. The insertion of a nasogastric tube, for example, can also be seen as an intervention in the patient's life that occurs without his consent.

If death occurs due to lack of fluids, this is not an excruciating suffering according to current knowledge, provided the mouth and throat are kept moist. There are even reports of a mood-enhancing or pain-relieving state in the case of a severe lack of fluids due to certain physiological processes. In this respect, not drinking fluids in the dying phase is medically and ethically justifiable and is described by representatives of the hospice movement as a possible way of making dying easier.

Otherwise, fluids and nutrients can be added to the body by infusion through the bloodstream or through a gastric tube. (A nasogastric tube is a small plastic tube that is inserted through the abdominal wall into the stomach through a small surgical procedure).

Another possibility, especially for patients who primarily have problems with fluid intake in the advanced stage of the disease, is to supply the fluid, if necessary, through a rectal infusion, i.e. through an enema through the anus, into the rectum.

How useful it is to place a nasogastric tube always depends very much on the individual circumstances. For example, if a sick person only has problems swallowing food and drinks and chokes very easily, but otherwise has a stable health effect, a nasogastric tube as a supplement to the limited intake of food through the mouth can significantly increase the patient's quality of life.

If, on the other hand, artificial nutrition is used in a very late phase of the illness, in which the patient appears very weak, it can indeed make it possible to extend the patient's life, but in this life, which has been extended by medical technology, the risk of considerable states of suffering is also through easily occurring infectious diseases such as pneumonia and bedsores are very large. Extending life in this phase therefore often also means prolonging suffering to a not inconsiderable extent and sometimes over a long period of time.

If a nasogastric tube is placed in a very weak condition of the patient, from which he can no longer recover, the decision to provide the patient with sufficient fluid and food in this way until his death is usually made irrevocably. For legal reasons, the nasogastric tube may then no longer be removed as long as the patient does not start again independently to ingest food through the mouth. Only if the patient has expressly rejected life-prolonging measures in the dying phase in a living will in advance or can be attested by other people that he has said this several times during healthy days, a decision to discontinue the nutrient intake is then still possible.

The course of dementia ultimately includes death. In this phase, as in the other phases of the disease, it is important to accept the effects of the disease and make decisions on this basis. Death is an inevitable consequence of the final stage of dementia.

There are no generally applicable rules for the decisions to be made in the final phase of the illness. There are always very personal decisions that the close relatives or the legal representatives of the sick person (the “legal guardians” or the authorized representatives) make in relation to the sick person's possible wishes and against the background of their own values. Relatives and legal guardians should, however, have the courage to really make their own decisions after weighing up all the circumstances and not, for example, let the doctor decide alone. Conversations with people who can listen and show understanding can help.

When making decisions in the last phase of the illness, one should try to put the patient's dignity and quality of life in the foreground.

The dying phase itself can take different forms. There are sick people who die very suddenly, sometimes almost unexpectedly, after a short period of physical weakness. Others are under the impression that they walk in very small steps over weeks or months as if they were slowly sliding over into another world. The dying phase itself can be very calm. Sometimes, however, it is also accompanied by restlessness, coughing, and difficult breathing due to physical symptoms such as pneumonia or because of mucus in the airways.

In summary, I would like to point out again at this point that the effects and course of Alzheimer's disease, as well as other dementias, can have many differences. With all the similarities, one should never rush to generalize and draw conclusions from one disease process on the other. Suggestions that seem sensible and important to one patient cannot be passed on to another without being questioned. The individual person must always be in the foreground.

A book in which the course of the disease and the symptoms are presented in detail, but also clearly and concisely, can be requested from AGJ-Verlag on Tel. (0761) 2 18 07-41, Fax: 28 63 52. It also contains many brief suggestions for care and a very topical section on diagnosis, drug treatment and basic research as well as model approaches to therapy and care.

Title: Understanding, caring for and treating people with Alzheimer's disease (178 pages) € 15.50

Authors: Jürgen Fischer, Günther Schwarz

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The brochure worth knowing about Alzheimer's disease and other dementias from the Alzheimer's advice center of the Evangelical Society Stuttgart e.V. was kindly provided by Dipl. Psych. Günther Schwarz. (As of September 2003)